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PRESS CREDENTIALS SUBMISSION FORM Please complete the "confidential" form below and fax it to 801.846.0429. Thank you. Personal Information: Name: Title: Company Name: Business Address: City| State | Zip: Country: Business Phone: Fax: Cell Phone: Pager Number: Business Email: Publication Name: (if applicable) Company or personal web page: http:// Media Pass Requested (Circle One): Newspaper Magazine TV Radio Internet Newsletter/Society Journal Other (describe here ___________________________________________) Scope: Local Regional State Multi-State National International Media Frequency: Daily | Weekly | Bi-Weekly | Monthly | Bi-Monthly Quarterly | Yearly | Other_______________________________ Other Media type or special requirements: Preferred method of contact (Circle one): Email FAX Mail I expect to attend the following event (please list here): ___________________________________________________ Date of Event______________________________________________ Please advise us of special deadlines or lead times required: Additional comments or questions: |
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| about us | |||||||||||||||||
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The Chambers Book Club for Children's Corporate Office Post Office Box 1334 * Rialto, CA 92377 * USA 909.873.5055 * Info@AchieveLifeSuccess.com © Copyright 2004; All Rights Reserved |
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