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Media Request Form
Media Request Form
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2022-06-06T21:02:41-04:00
Rev. Danté R. Quick, Ph.D.
Senior Pastor
Media Requests
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Contact Information
Name
*
First
Last
Title
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Phone
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Email
*
Social Media handles
*
Media Outlet
Name of Media Company
*
Primary type
*
Television
Print
Radio
Podcast
Website
*
Estimated Reach (e.g., circulation, viewership, etc.)
*
Interview Details
Story Angle
*
Sample Questions or Info Requested
*
Deadline
*
MM slash DD slash YYYY
Time
*
Hours
:
Minutes
AM
PM
AM/PM
Estimated Publish Date
*
MM slash DD slash YYYY
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