Interview Request Form

Interview Request Form

For Booking Information Or Media Requests, Contact Judy Landreth Wilkinson

JLWilkinsonConsulting@gmail.com | (706) 518-2116

www.JLWilkinsonConsulting.com

Client You Are Requesting To Interview:

Preferred Date For Interview:

YYYY

Time:

Time Zone:

Optional Dates And Times (include time zone) If Client Is Unavailable For Preferred Date:

Details

Contact Name Of Person Requesting Interview:

Email:

Phone:

Is An Honorarium Being Offered To Compensate For Client's Time? If So, Please List The Amount.

Title Of Person Requesting Interview:

Name Of Media Organization (please include network, name of show and station number if applicable):

Company/Show Description (please include website, social media pages, youtube channels, etc):

Interviewer's Name:

Will Any Other Guest(s) Be On The Show? If so, please list names and bios of others included on the interview:

Select Format

Radio Live

Radio Pre-recorded

Podcast Live

Podcast Pre-recorded

Television Live

Television Pre-recorded

Magazine Print

Magazine Online

Newspaper Print

Newspaper Online

Other

If Other, please describe:

Will Interview Be Audio Only or Video/Audio?

Link To Watch Or Listen To Interview:

How Will Interview Be Conducted?

In Studio (This requires 2 first class flights, 2 hotel rooms, meals and ground transportation)

Phone

Skype

Other

Zoom

If Other, please describe:

Topic(s) To Be Discussed:

Length Of Interview (usually 30 minutes):

Call In Phone Number and Back Up Phone Number (if applicable):

Skype Handle (if applicable):

Zoom Link (if applicable):

Transportation Information For In Studio Interviews (if applicable):

If Interview Is Not LIVE, When Will It Be Aired/Published?

Following The Interview, Please Send A Link That Allows Us To Share On Social Media Site And Websites. Email To: JLWilkinsonConsulting@gmail.com

IMPORTANT

To Help Prepare For Upcoming Interview, Client Bios And Headshots Are Available On Media Kit Located At
https://www.jlwilkinsonconsulting.com/speakers_performers

Signature

Verification