Contact Information

Full Name (per photo ID):

Preferred Name:

Birthday

Title/Position:

Email:

Cell Phone:

Address

Emergency Contact Name:

Emergency Contact Phone Number:

Special Food Requirements:

Health Concerns/Physical Limits:

Trip Information

Arrival Date:

Departure Date:

Please list number of guests, and who they are in relation to you.

Number of Guests:

Have you visited Durham before?

Yes

Publication Information

Are you on assignment?

Yes

Media Outlet(s):

Media Outlet Website(s):

Frequency, circulation, and reach

Media Outlet Notes:

Outline assignment details and story angles

Anticipated Coverage:

Length of Coverage:

Anticipated Publication Date:

Has your publication written about Durham before?

Yes

Links to Sample Coverage/Similar Stories

Assigning Editor:

Assigning Editor Email:

Do you plan on taking video?

Yes

Do you plan on taking photos?

Yes

Story Goals/Interest

Other Interests:

Social Media

Publication Facebook:

Publication Twitter:

Publication Instagram:

What platforms will you be posting on while you're here?

Travel Arrangements

How will you be arriving/departing?:

Lodging Accommodation (Number of Nights):

Please include details below.

Have you already booked accomodations/attractions/experiences?:

Lodging Accommodations

Hotel

Personal

N/A

Lodging Assistance Requested

None

Complimentary

Media Rate

N/A

Additional Information

What interests you about Durham as a destination?:

Is there anything specific you would like to do or see in Durham?:

Please note specific interview requests.