ISWA/126-Media Communications and Interview Form

For Media Outlet:
Thank you for you interest in our organization. Please fill out the form in its entirety and we will review upon completion.

1Media Communications Form > 2For Top Management > 3Review Your Entry
Name of Company/Publication/Social Media Outlet Etc.:
Phone number (include country code)
Email
Web Site
Name of Person Submitting Form: Name of Person Submitting Form: Title First Middle Last Suffix
Title Person Submitting Form:
What is the topic of the interview? Specific questions or information must be submitted.
(A separate document may be uploaded)
Upload interview/media questions here:

Attach Files
When is your deadline?
(If none, write N/A)
List any equipment needed for interview and who should provide it (camera, recorders, etc.)
Method of interview or related communication (i.e. skype, in-person interview, phone call, etc.)
Where will the interview or communication be published?
(specific website or location must be submitted)
Expected Date of Publication
I agree to share the published documentation of the interview or communication as soon as it is ready (Must agree)

I agree to share the published documentation of the interview or communication as soon as it is ready (Must agree) Yes