1. Name
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First
*
Last
*
Title
2. Your E-mail Address
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Work E-mail
*
Personal E-mail
3. Company (skip this area if you are stictly freelancing)
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Company Name
University (if affiliated with one)
Type of Media (Newspaper, Magazine, TV Program, Website, Radio Syndicate)
How often do you publish or air?
Daily
Weekly
Monthly
Annually
Other
If other, please describe.
How would you describe the primary editiorial focus of your outlet (Rock, Country, General News, Entertainment News, Men, Women, Teens, Farm Machinery, etc.)?
4. Your Location
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What is the major metropolitian area nearest to where you live?
Abilene-Sweetwater, TX
Albany, GA
Albany-Schenctady-Troy, NY
Albuquerque-Santa Fe, NM
Alexandria, LA
Alpena, MI
Amarillo, TX
Anchorage, AK
Atlanta, GA
Augusta, GA
Austin, TX
Bakersfield, CA
Baltimore, MD
Bagnor, ME
Baton Rouge, LA
Beaumont-Port Arthur, TX
Bend, OR
Billings, MT
Biloxi-Gulfsport, MS
Binghamton, NY
Birmingham-Anniston, AL
Bluefield-Beckley-Oak Hill, WV
Boise, ID
Boston, MA
Bowling Green, KY
Buffalo, NY
Burlington-Plattsburgh, NY-VT
Butte, MT
Casper-Riverton, WY
Cedar Rapids-Waterloo & Dubuque, IA
Champaign & Springfield-Decatur, IL
Charleston, SC
Charleston-Huntington, WV
Charlotte, NC
Charlottesville, VA
Chattanooga, TN
Cheyenne-Scottsbluff-Sterling, WY-NE
Chicago, IL
Chico-Redding, CA
Cincinnati, OH
Clarksburg-Weston, WV
Cleveland, OH
Colorado Springs-Pueblo, CO
Columbia, SC
Columbia-Jefferson City, MO
Columbus, GA
Columbus, OH
Columbus-Tupelo-West Point, MS
Corpus Christi, TX
Dallas-Fort Worth, TX
Davenport-Rock Island-Moline: Quad City, IL-IA
Dayton, OH
Denver, CO
Des Moines-Ames, IA
Detriot, MI
Dothan, AL
Duluth-Superior, MN-WI
El Paso, TX
Elmira, NY
Erie, PA
Eugene, OR
Eureka, CA
Evansville, IN
Fairbanks, AK
Fargo-Valley City, ND
Flint-Saginaw-Bay City, MI
Florence-Myrtle Beach, SC
Fort Myers-Naples, FL
Fort Smith, AR
Fort Wayne, IN
Fresno-Visalia, CA
Gainesville, FL
Glendive, MT
Grand Junction-Montrose, CO
Grand Rapids-Kalamazoo-Battle Creek, MI
Great Falls, MT
Green Bay-Appleton, WI
Greensboro-High Point-Winston-Salem, NC
Greenville-New Bern-Washington, NC
Greenville-Spartanburg-Ashville-Anderson, NC-SC
Green-Greenville, MS
Harlingen-Weslaco-Brownsville, MCAllen, TX
Harrisburg-Lancaster-Lebanon-York, PA
Harrisonburg, VA-WV
Hartford & New Haven, CT
Hattiesburg-Laurel, MS
Helena, MT
Honolulu, HI
Houston, TX
Huntsville-Decatur, Florence, AL
Idaho Falls-Pocatello, ID
Indianapolis, IN
Jackson, MS
Jackson, TN
Jacksonville-Brunswick, FL-GA
Johnstown-Altoona, PA
Jonesboro, AR
Joplin-Pittsburg, MO-KS
Juneau, AK
Kansas City, MO
Knoxville, TN
La Crosse-Eau Claire, WI
Lafayette, IN
Lafayette, LA
Lake Charles, LA
Lansing, MI
Laredo, TX
Las Vegas, NV
Lexington, KY
Lima, OH
Lincoln & Hastings-Kearney, Plus, nE
Little Rock-Pine Bluff, AR
Los Angeles, CA
Louisville, KY
Lubbock, TX
Macon, GA
Madison, WI
Mankato, MN
Marquette, MI
Medford-Klamath Falls, OR
Memphis, TN
Meridian, MS
Miami-Fort Lauderdale, FL
Milwaukee, WI
Minneapolis-Saint Paul, MN
Minot-Bismarck-Dickinson (Williston), ND-MT
Missoula, MT
Mobile-Pensacola, AL-FL
Monroe-El Dorado, LA-AR
Monterey-Salinas, CA
Montgomery, AL
Nashville, TN
New Orleans, LA
New York, NY
Norfolk-Portsmouth-Newport News, VA
North Platte, NE
Odessa-Midland, TX
Oklahoma City, OK
Omaha, NE
Orlando-Daytona Beach-Melbourne, FL
Ottumwa-Kirksville, IA-MO
Paducah-Cape Girardeau-Harrisburg, Mount Vernon, KY-MO-IL
Palm Springs, CA
Panama City, FL
Parkersburg, WV
Peoria-Bloomington, IL
Philadelphia, PA
Phoenix, AZ
Pittsburgh, PA
Portland, OR
Portland-Auburn, ME
Presque Isle, ME
Providence-New Bedford, RI-MA
Quincy-Hannibal-Keokuk, IL-MO-IA
Raleigh-Durham, NC
Rapid City, SD
Reno, NV
Richmond-Petersburg, VA
Roanoke-Lynchburg, VA
Rochester-Mason City-Austin, IA-MN
Rockford, IL
Sacramento-Stockton-Medesto, CA
Saint Joseph, MO
Saint Louis, MO
Salisbury, MD
Salt Lake City, UT
San Angelo, TX
San Antonio, TX
San Diego, CA
San Francisco-Oakland-San Jose, CA
Santa Barbara-Santa Maria-San Luis Obispo, CA
Savannah, GA
Seattle-Tacoma, WA
Sherman, TX-Ada, OK
Shreveport, LA-AR
Sioux City, IA
Sioux Falls (Mitchell), SD
South Bend-Elkhart, IN
Spokane, WA
Springfield, MO
Springfield-Holyoke, MA
Syracuse, NY
Tallahassee-Thomasville, FL
Tampa-Saint Petersburge, Sarasota, FL
Terra Haute, IN
Toledo, OH
Topeka, KS
Traverse City-Cadiallac, MI
Tri-Cities, TN-VA
Tucson (Nogales), AZ
Tulsa, OK
Twin Falls, ID
Tyler-Longview (Lufkin & Nacogdoches), TX
Utica, NY
Victoria, TX
Waco-Temple-Bryan, TX
Washington, DC
Watertown, NY
Wausauo-Rhinelander, WI
West Palm Beach-Fort Pierce, FL
Wheeling-Steubenville, WV-OH
Wichita Falls & Lawton, TX-OK
Wichita-Hutchinson Plus, KS
Wilkes Barre-Scranton, PA
Wilmington, NC
Yakima-Pasco-Richland-Kennewick, WA
Youngstown, OH
Yuma-El Centro, AZ-CA
Home/Personal (Street Address)
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Address 1
Address 2
City
State
Zipcode
Home Personal (P.O. Box)
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Address 1
Address 2
City
Zipcode
State
Work (Street Address)
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Address 1
Address 2
City
State
Zipcode
Work (P.O. Box)
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Address 1
Address 2
City
State
Zipcode
5. Your Phone and Fax
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Work Phone and Extension
Work Fax
Home Phone
Home Fax
Cell Phone
Work URL
Personal URL
6. Your Freelance Information
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List the outlets you freelance for (up to 10)
Is there anything else we should know about you? For instance, when is the best time to call you? What time or day is your deadline? How long is your lead time to receive materials in order to write about them? Any information on how you would like us to work with you to make your job easier would be appreciated.
8. Your Notes