|
| As a member of the media (print, broadcast, online/blog, etc.), we ask that you provide the following information regarding your accommodations request.
|
|
| Name:
|
|
| Title:
|
|
| Publication/Freelancefor:
|
|
| Circulation/Audience/Site Traffic:
|
|
| Business Address:
|
|
| City:
|
|
| State:
|
|
| Postal or Zip Code:
|
|
| Country:
|
|
| Phone:(1-313-555-1212 ext. 213)
|
|
| Fax:
|
|
| Email:
|
|
|
Media Information
If you would like to receive special media rates, fill out the information below.
|
|
| Story Assignment:
|
|
| Anticipated Publication Date:
|
|
| Number of people in party:
|
|
| Benefit to hotel:
|
|
| Name of editor:
|
|
| Phone: (1-313-555-1212 ext. 213)
|
|
|
Location and Dates
Please enter your hotel information.
|
|
| City/Cities:
|
|
| State:
|
|
| Country:
|
|
| Hotel Name:
|
|
| Arrival Date:
|
|
| Departure Date:
|
|
|
Special Requests
Please enter any special requests below.
|
|
| Complimentary Accommodations
Press Rate
Either press rate or comp. accommodations are acceptable
|
| Please enter your request:
|
|
|
|
|
