Media Visit Request

Journalist Information

First Name (as per photo ID):

Last Name (as per photo ID):

Date of Birth:

Title:

Email:

Phone Number:

(Please include area code and/or country & city code)

Mobile Phone:

Mailing Address:

Address (cont.):

City:

State:

Zip/Postal Code:

Country:

What is your English speaking capacity?:

How can we best contact you during your stay in The Palm Beaches?:

Email

Mobile Phone

List any personal medical conditions/allergies
If none, please write NONE:

Emergency Contact

Emergency Contact Name:
Relationship to you:
Mobile Phone:

Media Outlet / Publication

Media Outlet / Company you will be writing for:

Description:

Medium:

Broadcast
Print Publication
Radio

Social Media
Digital Publication

Print Circulation/Reach:

Readership:

Trade
Consumer

Target Audience:

Audience Demographics:

Reader Median HHI:

Region of distribution:

Media Outlet website:

Assignment Details

Published Articles

Please include links to at least three of your bylined articles that have been published within the last two years.
Article 1:
Article 2:
Article 3:
Article 4:
Article 5:
Upload a PDF of print coverage:

Social Media

Will your travels be shared on the media outlet’s social media channels?:	udf_541 Yes No If so, please include direct links for those that apply.
Facebook:
Twitter:
Instagram:
YouTube:
Pinterest:
Other:
Other:

Trip Details

Date of Arrival:

MM/DD/YYYY *Media Visits cannot be guaranteed for major holidays or holiday weekends including: Thanksgiving, Christmas, New Year's, Labor Day, 4th of July and Memorial Day.

Expected time of arrival:

Date of Departure:

MM/DD/YYYY

Expected time of departure:

Will you need accommodations?:

If yes, number of rooms needed?:

Number of individuals:

Names of individuals who will be traveling with you and their titles:

*Discover The Palm Beaches does not guarantee costs/expenditures
of non-media related guests, such as spouse or children.

How will you be arriving to The Palm Beaches?:

Flying
Driving
Other (add details below)

Other Arrival Details:

Which airport will you be flying in to?:

Palm Beach International Airport (PBI)
Fort Lauderdale International Airport (FLL)
Miami International Airport (MIA)
Southwest Florida International Airport (RSW)
Orlando International Airport (MCO)

Will you require ground transportation assistance during your visit?:

Would you rather experience more planned activities or leisure time?:

Have you made any independent arrangements we should be aware of?:

Is there anything else you would like to
share with us?:

Terms and Conditions

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Media Visit Request

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