Address:


City:


Zip:


Contact Person who is handling this project:

Contact Person Work Phone Number:


Contact Person Cell Phone Number:


Contact Person Home Phone Number:

Contact Person Fax Number:


Contact Person E-Mail Address:

Executive Director:


Executive Director Work Phone Number:


Executive Director Cell Phone Number:


Executive Director Home Phone Number:

Executive Director Fax Number:


Executive Director E-Mail Address:


(Please note that the Executive Director will need to approve all media information; Easy PR projects, prior to their release either by signing and faxing material or through edit via email.)

Media Request is for:
Event Press Briefing/Conference Story to be covered
Announcement of program changes/awards or honors

Expected date of Release:


Papers/TV or Radio to cover this project (fill out section for each station, paper, magazine, etc.)

Name of First Media Outlet:


Media Outlet Address:


Media Outlet Phone:


Media Outlet Reporter/Contact:


Name of Second Media Outlet:


Media Outlet Address:


Media Outlet Phone:


Media Outlet Reporter/Contact:


Name of Third Media Outlet:


Media Outlet Address:


Media Outlet Phone:


Media Outlet Reporter/Contact:


People to be interviewed regarding this project:

First Interviewee Name:


Phone:


Email Address(if available):


Second Interviewee Name:


Phone:


Email Address(if available):