Visiting Journalists Request Form

Red fields are required field

Trip Information
Arrival Date
Arrival Time
Departure Date
Departure Time
Journalist Information
First Name
Last Name
Journalist Type
Specify Journalist Type Here
Address 1
Address 2
City
State / Province
Zip Code
E-mail
Cell Phone
Phone	Extension:
Fax
Is this your first time visiting?	Yes
What Pocono Mountains locations have you visited previously?
Assignment secured?	Yes
Projected publish date
Estimated length (pp/mins)
Story line, angles
Requested experiences
Publication Information
Publication Name(s)
Publication Frequency
Target Market
Address 1
Address 2
City
State / Province
Zip Code
E-mail
Website
Phone
Publication focus, niche
Audience demographic
Circulation/audience #
Advertising rates
Media value of article
Visit Details
Number of journalists
Number of non-journalists
Number of rooms requested
Region visit will include	Lake Lehigh River Gorge Mountain Upper Delaware River Delaware River
Budget amount
Requested Arrangements
Lodging
Room Type
Dietary restrictions
Physical restrictions
Host
Additional materials requested	Photography Other
Other materials requested

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The Pocono Mountains
A Forgotten Vacation
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