Media

Applications are live, but will not be accepted until Charity Concert is CONFIRMED.

Prior to completing this form, please read the Guidelines and Requirement below. Check each true statement.

Check each true statement. *

The applicant an employee of the Media source that they represent. The applicant has been authorized by their employer to represent them. The applicant has obtained a National Background Check for each representative and is attached.

* Indicates required field

Upload copy of each representative's signature in WET INK on one document. *

Max file size: 20MB

please complete fully.

Media Source *

Media Source's Address *

Line 1

Line 2

City

State

Zip Code

Country

Media Source's Phone Number *

There's a limit of five representatives per Media source.

Representative's Name *

First

Last

Representative's Name *

First

Last

Representative's Name *

First

Last

Representative's Name *

First

Last

Representative's Name *

First

Last

Lead Representative's Email *

Copy of Background Check *

Max file size: 20MB

Submit

media application

please complete fully.