Social Media Influencers & Content Creators

Contact Information

First Name:
Last Name:
Address:
City:
State:
Zip/Postal:
Primary Phone:
Email:
You have permission to contact me via email:	contact_sendemail Yes No

Media Information

Are you an Influencer/and or Content Creator?:

Attach Media Kit:

(and/or rate card below)

Attach Rate Card:

(and/or media kit above)

Facebook URL:

Instagram URL:

TikTok URL:

Twitter Username:

Website/blog:

Other (social media):

Can we interact with you via Social Media while you are in Winston-Salem:

Yes No

What platforms will you likely post on during and/or after your visit?:

Facebook
Instagram
Twitter
Youtube
No Planned Coverage

Interests / Preferences

Itinerary Information

Preferred travel dates: Please list your preferred dates and then two sets of alternative dates
Do You Need Ground Transportation?:	udf_176 Yes No
Do You Need Accommodations?:	udf_177 Yes No
	If yes, will you mention the hosting accommodation in your in your story? (check if yes)
	If complimentary accommodations are not available, will you accept press rates? (check if yes)
If you have arranged for accommodations, please name the property:
Will You Be Traveling with Guests?:	udf_181 Yes No
If so, please list their names and relationship to you:
Preferred Itinerary Type:

Emergency Contact Information

Emergency Contact Name:
Emergency Contact Relationship:
Emergency Contact Phone:

Verification:

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