Personal Information

• *First Name:
• *Last Name:
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• *Website:
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• Add Me to Your Distribution List? Yes No

Media Outlet Information

• *Media Outlet Name:
• *Address:
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• *Website:
• *Circulation/Audience Size:
• *Distribution Area:
• *Expected Run Date:
• *Story Angle Focus:
• *Are You Visiting on Assignment? Yes No
• Upload Letter of Assignment

Media Visit Information

• *Expected/Desired Arrival Date:
• *Expected/Desired Departure Date:
• Last Visit to Jacksonville:
• *Hotel Arrangement Needed? Yes No
• *Are There Any Others Traveling in Your Group? Yes No
• If Yes Please Explain:
• *If Complementary Accommodations are not Available Will You Accept a Media Rate? Yes No
• *If Yes, Will You Mention the Hosting Hotel in Your Story? Yes No
• Description of Story/Interests:
• *Activities Requested (specify how many tickets/passes):
• *Will these Activities by Included in the Story? Yes No
• *Car Rental Required? Yes No
• Special Requests:
• How Can Visit Jacksonville Assist?
• Develop Full Itinerary
• Suggestions for Activities
• Meeting During Your Visit
• Other
• If Other Please Describe:
•