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INTERVIEW REQUEST FORM:

This form allows you to request an interview with a representative regarding the First Lady Conference. Simply fill out all sections of the form. Interview requests are handled regularly each weekday; if your interview request is extremely urgent, please call (972) 267-1111.

Your Name

Title

Media Outlet

Type of Media

Circulation/Coverage

Address ( include city, state, zip)

Phone Number

Fax Number

Email Address

Client
The First Lady Conference

Person to Interview

Requested Date

Requested Time

Length

Interviewer

Location Preference

Topics

Date to Run

Format of the Segment

Special Notes & Information