Interview Request Form

Today's Date:

Name:

Title:

Media Outlet:

Media Website:

Phone Number:

Fax Number:

Email Address:

Interview Date:

Deadline:

Person to be

Interviewed:

Purpose for

Interview:

Interview Length:

Reporter

Biography:

This form allows you to request an interview. Upon receipt, your information will be recorded, reviewed, and a Public Relations staff member will contact you regarding your request. In the interim, if you have an inquiry, please e-mail: publicrelations@tdjakes.org