Media inquiry

Contact details
Name*
First Last
Media outlet*
Email*
Phone*
Inquiry details
What is the nature or your request or inquiry*
Are you working on a deadline?*
- Yes, I am working on a deadline
- No, I am flexible on timing to receive a response
Deadline date:
MM slash DD slash YYYY
Deadline time:

: Hours

Minutes

AM/PM
What type of response do you need?
- Statement
- Phone interview
- In person on-camera interview
- Zoom (or similar) interview
- Other
Other type of response:
When will interview or story run?
MM slash DD slash YYYY
Additional comments:

Contact details