Please take a moment to complete this short worksheet. This will give us some idea of how we can make your visit a successful one. We will need this completed prior to making the arrangements for your visit.

Visiting Media Worksheet

Purpose of Visit:
Dates of Visit:	-  (Example: 3/5/04-3/25/04)
Name:
Title/Beat:
Address:
City:
State:	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
	Other:
Zip/Postal Code:
Phone:
Fax:
Email:
Number in Party:	Select below... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Professional Organization Membership:	SATW	TMAC	Midwest Travel Writers
	Other? Please specify:
Story assignment?:	Yes	No
Freelance Writer:	Yes	No
Media outlet:
Expected story run date:
Please check one:	Broadcast TV	Cable TV	Radio
	Newspaper	Magazine	Online
Editor/Producer's Name:
Editor/Producer's Phone:
Crew attending  (number on the crew and equipment)
Preferred Activities:
If visiting on an individual trip:
	Accommodations  needed/desired  type of lodging:
	Number of Nights:
Please list any dietary,  accessibility or  other special needs:

If you have any questions about visiting Ohio, please contact Tammy Brown at the Ohio Division of Travel and Tourism at tbrown@odod.state.oh.us or 614-466-8591. Thank you!