JIC INTERVIEW OR PHOTO REQUEST

Please provide the following information. We will do our best to respond to you in a timely manner.

Date:
Time:
Name:
Title:
Program Title:
Host:
Media Outlet:
City:
State:
Country:
Work Phone:
Work Fax:
Cell Phone:
Pager:
E-mail Address:
WHO would you like to interview or photograph? Or, anyone available?
WHAT is the general subject or story angle and interview topics to be covered?
WHEN is your deadline to conduct this interview or photograph? (Local Houston time)
WHERE would you like to schedule this interview or photograph?
Can you conduct this interview by phone?
Yes
No
Prefer not to
HOW long would the interview or photo session last? _______ minutes
HOW will the interview or photo session be conducted? Select all that apply:
In English
In another language (specify below)
For Broadcast
For Print
Live Broadcast
Recorded for later broadcast or publication
If in other language(s), specify language(s)
If live broadcast what date/time (local Houston time) would the interview air?