MATERIALS REQUEST FORM

Personal Information:

Name:

Title:

Media Affiliation:

Street:

City:
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About Your Media Outlet:

Company/Publication Name:

Circulation/Audience Size:

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Frequency of Publication/Broadcast:

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City:
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About Your Visit:

Confirm date of arrival (mm/dd/yy):  

Confirm date of departure (mm/dd/yy):

Hotel arrangements needed? Yes No
If yes, can you mention the hosting hotel(s) in your story? Yes No

If you already arranged hotel accommodations, please indicate the hotel:

If complimentary arrangements are not available, will you accept press rates? Yes No
If yes, what range?

Room preference?

	Single
	Double
	Non-smoking

Number of people in party (include names and titles):

Have you ever visited Oregon's Mt. Hood Territory or Oregon? Yes No

If so, when was your last trip?

Type of story planned:

Special interests (i.e. shopping, dining, budget, seniors, family, adventure, heritage, agritourism, etc.):

Comments/other requests:

Materials Requested:

Please share my name with Oregon's Mt. Hood Territory's partners, so that I may receive:

If you are not a working member of the media, please contact us.