INTERVIEW CHRISTINE

Please complete the form below so that our team can better serve you as we consider this request.

First Name *

Last Name *

Email *

Name of Individual Completing Form (If Not Interviewer)

In which format will the interview be published? *

Will the interview be recorded or live? *

In which format are you requesting the interview be conducted? *

What is the length of time being requested to conduct the interview? *

Please describe your deadline for completing this interview *

Please provide a bio/description of the outlet where this interview will be published *

Please describe the target audience of the outlet *

What is the average reach of the outlet? *

Please provide website address or other online information *

Please provide bio of the interviewer *

Please provide a brief summary of the topics you would like to discuss *

Please describe any supplemental material required for publication *

(i.e. Photos, Videos, etc.) If none needed, please list none.

Outlet Name *

Confirmation Content

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INTERVIEW CHRISTINE

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