MEDIA REQUEST FORM

Mt. Hood Territory offers assistance to qualified media intending to provide coverage of the destination, though resources and staff time are limited. Interested parties should complete a media assistance request form detailing their specific needs at least four (4) weeks prior to intended travel dates. Mt. Hood Territory reserves the right to decline any request.

DATES

Date of Request

Arrival Date

Arrival Time

Arrival Location

Departure Date

Departure Time

Departure Location

JOURNALIST INFORMATION

Name as it appears on passport or government issued ID *

Date of Birth

Street Address

City, State, Zip Code, Country

Work Phone *

Mobile Phone *

Can we reach you on your mobile number while in The Territory?
No
Yes

Email Address *

Best way to reach you while you are in The Territory

Are you a smoker or a non-smoker?
Non-Smoker
Smoker

Valid Foreign Travel Health Insurance (if applicable)
No
Yes

Allergies/Dietary Restrictions

Health Concerns/Physical Limitations

Are you a first time visitor?
No
Yes

If not, which Mt. Hood Territory locations have you visited previously

SOCIAL MEDIA HANDLES

Twitter

Instagram

Pinterest

YouTube

Facebook

MEDIA OUTLET

Outlet Type

TV
Newspaper
Magazine
Website
Social
Other

Outlet Name

City, State, Country

Outlet Niche/Focus

Audience/Demographic

Circulation/Audience #

Media value of article

Assignment Secured?
No
Yes

Estimated Length

JOURNALIST OBJECTIVE

Please select all that apply

Reporter
Freelancer
Photographer
Producer
Blogger
Social Media Influencer

Other:

Storyline/Angles

Request areas in Mt. Hood Territory to include in itinerary

Meeting Requests (specific individuals or organizations you would like to interview)

Sights, attractions and activities you would like to experience

Preferred Itinerary Style
Action Packed: Set appointments and interviews throughout the day with some time for exploring on my own

Best of Both: A few set appointments each day with ample time to explore on my own

Solo Explorer: Hotel nights booked but mostly suggested meals and attractions that I will explore on my own

Other (please explain)

Do you plan to include accommodation listings or reviews in your coverage?
No
Yes

Do you plan on including Mt. Hood Territory's website, mthoodterritory.com?
No
Yes

TRAVEL ARRANGEMENTS

Number of Media

Number of Non-Media

Bringing a Photographer?
No
Yes

Travel Host
I need a travel host
I would prefer to travel on my own

If complimentary accommodations are unavailable, would you accept a media rate?
No
Yes

Mode of transportation to Mt. Hood Territory
Car
Flight
Train

Transportation while in The Territory
Rental Car (book on your own)
Rental Car (need booked)

Room Preference (if any)

Additional Comments

* Please Enter All Required Fields