Publicists Registration Form

* Required Field
* Company Name
* Contact Name
* Contact Position
* Address
* City
* State
* Zip Code
* Country
* Phone Number
Cell Number
* Email
Fax
   
Name of the client you want us to cover
Is there any upcoming event?
Yes No
If so, what is the date of the next event
Click Here to Pick up the date
If this is an ongoing event, what day of the week does this happen and what is the frequency
Is there an opportunity to receive press passes/tickets/ comps?
Yes No
Is your client a non-profit organization?
Yes No
Have you received or do you intend to receive payment or compensation for representing this client?
Yes No
Your name
Your position

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