Rockridge Institute Media Appearance Request Form

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If you would like to interview a Rockridge expert, please take a moment to fill out this form so that we have all the information we need to respond to you as quickly as possible. If you have other urgent questions, call our office at 510-204-0646 or send an email to info@rockridgeinstitute.org.

INSTRUCTIONS: Fill out as much of this form as possible.

Media Appearance Request

Publication or show name (Required)

Person conducting the interview (Required)

Rockridge expert(s) requested

Contact person (Required)

Daytime Telephone (Required)

Cell Phone

Contact E-Mail Address (Required)

Publication/Show Website

Interview Type

E.G., phone or in person, and live or taped.

Location

If in person.

Date(s) Requested

Time of the Event

Deadline

Description/Purpose/Topic to be discussed

Expected publication or broadcast date

What is your audience reach?

Will this interview be available online in some form?

Yes
No

Would you accept a pre-taped interview?

Yes
No

Will there be any political commentary in the presentation(s)?

Yes
No

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