MOM’s Media Request Form
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What type of project is this shoot request for? *
Company Requesting Shoot (i.e., show, magazine, station, production company): *
Contact Name *
Contact Email Address *
Contact Telephone Number *
Preferred MOM's Location for Shoot/Interview? *
*Ideal Shoot/Interview Date(s): *
*Please note, we generally don’t allow filming on weekends:
*Time Frame for Shooting/Interview (i.e., 8-9am): *
*Please note, flexibility on dates, times, and locations may determine if we can assist you
How long will filming/photography/interview take? *
How many crew members will there be? *
Specific Location Inside/Outside Store (i.e., produce section, parking lot, etc.): *
Equipment/Large Props being used (i.e., lights, cameras, etc.): *
Summary of Project/Show/Article in which the content, photo or video footage will appear:   *
Audience/Ratings Info:
Website (if applicable):
Approximate air/publication time and date: *
Will you need a MOM’s spokesperson? Will anyone from MOM’s be featured? (Team Members in the background, cashiers, etc.) *
Will MOM’s benefit from this shoot? How? *
Will MOM’s signage be shown? *
If your request is approved, store management reserves the right to dictate/change location/time of filming in order to ensure our customers may shop uninterrupted. *
**Please note: A video or clip of this article/segment MUST be shipped to MOM’s when the project is complete. Ship to: MOM’s Organic Market, Attn: Communications Team, 5612 Randolph Road, Rockville, MD 20852
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This form was created inside of MOM's Organic Market.