Media Support Form

We only need minimal information to make an entry. Keep in mind what you have seen displayed for other entries on our media page as you enter the information here.
Enter your email address:

Is your media entry of Nationwide recognition,
or primarily within a specific state:  Select One National Specific State
What is the name it is recognized by (paper name or station call letters, be brief, do not repeat the word magazine, newspaper, etc..): --

If NOT Nationwide, what is the State: Select One Alabama Alaska Arizona Arkansas California California Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylavania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
If NOT Nationwide, what is the City name:

Enter the type of media: Select One Magazine Newspaper Radio Television Other
What is the FAX number:
What is an E-mail address:

Complete only ONE of the following additional depending on the type of media.

• Radio - AMFM,  Frequency
• Television - Local Channel Number