1. What is your Name?

2. Give a few sentences on who you are and what your expertise is:

3. What are a few stories/angles you think would be interesting for a TV Interview?:

4. Why are you passionate about your topic?

5. Who are you trying to reach with your media messages? (Who is your right fit audience?)

6. What are the needs of the audience you are trying to reach?

7. When are you hoping to become an Ambassador and start using interviews as powerful marketing? (Right now people are waitlisted but we are about to open a new round of Ambassadors entering the program.)

8. Can you include a website or links for us to check out? We'd like to see if you'd be a fit / have something that would be interesting to the media. (Also include media experience or share links if you have them.)

9. How can we best reach you? Include your contact information here.

10. How did you hear about us? / Is there anything else you'd like us to know?