Date |
|
Name |
|
Title |
|
Organization |
|
Street Address |
|
Address (cont.) |
|
City |
|
Statee |
|
Zip/Postal Code |
|
Country |
|
Work Phone |
|
Home Phone |
|
FAX |
|
E-mail |
|
URL |
|
Do you wish to personally appear on the show or Call in? |
|
What show Date (s) do you wish to participate in? |
|
List all topics here you feel might be worth
covering during your part of the show.
Also, list any fund raising events you are planning. |
|
List all your awards, accomplishments, credentials,
degrees, etc. that may be helpful in promoting your part of the show before,
during, and after the actual show time. |
|
List any civic, sports, awards, or other organizations you belong to. |
|
List personal information like family, where you were born, grew up,
hobbies, etc. |
|
List your position and titles, work history, etc. |
|
List who or what referred you about being on the show |
|
Your Current Employer |
|