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Proposed Date(s) of interview:
1st choice:
Month January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
2nd choice:
3rd choice:
Length of time requested:
Purpose for this interview:
Number of cameras atinterview
TV Still
Discussion Points:(500 character max)
Attending (include names and positions)(NOTE: Only people listed will be admitted to this interview - 500 character max)
Name of interviewer:
Position / Title:
Media Organization:
Type of media organization:
Print TV Radio Other
Address:
City / State / Zip:
Phone:
Fax:
Email:
Website address:
Attaching a file?
Yes No
Attach any additional information or questions:
PLEASE NOTE: You will be notified within two weeks of the submittal of this form as to whether your request has been granted or denied. If you are requesting a date that is more than 45 days away, you will not receive final determination until your requested date comes within that time frame.
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