Tin Pan South Media Application

TIN PAN SOUTH MEDIA REQUEST FORM

Media Outlet

Name

First

Last

Phone

E-mail

Outlet Platform

Outlet Platform - Select -TVPrintOnline NewsSocial MediaRadioFreelanceOther…

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Demographic and Audience Reach Information

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Website

Facebook

Instagram

Other Social

Please list any specific performers or shows you are interested in covering:

Number of Tickets/Credentials Requested (this would be per show approved) - Select -12

Provide Names for Ceredentials/Tickets

Please provide any additional details / information below for your request: