Request For Press Coverage Please fill out this form in its entirety Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Personal DetailsContact Name *FirstLastLayoutEmail *Contact Phone *Business DetailsBusiness Name *Coverage Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCoverage Needed: *Please Select OneNew Product LaunchMerger and AcquisitionProduct UpdateEventGrand OpeningNew PartnershipRebrandingExecutive PromotionAwardEvent DescriptionMedia ReleaseThe Media Can Be Used in the Following: *VideosPhotosEmail MarketingSocial MediaNewsletters/MagazinesWebsiteOtherCheck all that applyConsent *I hereby consent to the use of my image, audio, and videoRelease of Liability *I hereby agree to release all liability from this organizationTerms and Conditions *I hereby agree to the following terms and conditions1. YOUR AGREEMENT By agreeing to this media release form, you agree to be bound by, and to comply with, these Terms and Conditions. If you do not agree to these Terms and Conditions, please do not use tick the box. PLEASE NOTE: Integrated Media Group, Inc./ BLKPRENEURSHIP reserves the right, at our sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Filling out the 'Request for Press Coverage' form is not a guarantee for coverage. The submission of this form is for consideration only. We will review all requests within 2-3 business days and will notify contact individual of our decision. Please review these Terms and Conditions periodically.Today's Date *Signature *Clear SignatureSubmit Share this: Share on X (Opens in new window) X Share on Facebook (Opens in new window) Facebook Share on LinkedIn (Opens in new window) LinkedIn Like this:Like Loading... 2024-01-19
