EmailMe Form - My Publicist Client Prospectus Form

Unique ID

A description of the section goes here.

Your Legal Name

Prefix First Last Suffix

Product/Performance/Stage Name *

Date of Birth

MM / DD / YYYY

Phone *

### - ### - ####

Cell *

### - ### - ####

Personal Email *

Web Site

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

A description of the section goes here.

Do you have a Brand or Public identity?

File Upload

Social Networks

A description of the section goes here.

Name of BUSINESS

Manager/Agent

Management Phone

### - ### - ####

Business, Manager/Agent Email

Manager/Agent Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

A description of the section goes here.

What is your monthly Publicity budget ?

$ Dollars . Cents

Have you received local, regional or national notoriety?

Local

Regional

National

How have you been reaching your customers or targeted audience?

Upload any examples

Briefly tell us about your Product, Service or Brand.
Then, Briefly describe your greatest promotional challenges.

Briefly convey your short and long term goals.

What would you like to accomplish in the first 3 months

Now, describe the image that you want to project for your business, product, or service?

Be open, honest and real.

THANK YOU FOR TAKING THE TIME TO AFFORD US THIS INFORMATION!!
WE WILL CONTACT YOU SOON.