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Young Indigenous Minds Media Coverage Application Form
Sign up for Media Coverage, Starting at 100$.
* Indicates required question
Email
*
Record my email address with my response
Name (
First And Last)
*
Your answer
Event Name
*
Your answer
Event Location (Phoenix Az Only)
*
Your answer
Event Date
*
MM
/
DD
/
YYYY
Event Time
*
Time
:
AM
PM
Would you like an edited 30 second interview?
*
No
Yes
Other:
Payment Method
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Digital/ Apple Pay, Samsung Pay, Google Pay,
Cash
Cash App
Card(Contactless, Chip, Or Magstripe)
Other:
What is the best way to contact you?
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Email
Phone
Mail
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Your answer
Send me a copy of my responses.
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