Morning Mix Request Form
Interested in being featured on Morning Mix? Tell us a little more about you.
Are you a business or non-profit?
Description of event or topic
Type your bio information here.
Type a list of props you may need to bring for the segment?
Are you providing graphics and/or video for this segment?
Are you providing your company's logo and/or additional graphics, photos or videos? If yes, please submit here:
My Vaccination Status (Covid-19)
I am fully vaccinated.
I am not yet fully vaccinated.
I have not been vaccinated.
I decline to respond.
Covid-19 Proof of Vaccination *
I understand that if I decline to respond or am not fully vaccinated, I will not be allowed to enter WRDW/WAGT premises.
Please attach a copy of your vaccination card:
Consent and Validation *
I certify to the best of my knowledge that this information is accurate. Also, I consent to have my temperature checked upon arrival at WRDW.
I refuse to have my temperature checked.
Please enter your date of birth.
Terms and Conditions
I have read, understand, and agree to the
Terms of Service
I Agree to the Terms and Conditions
Should be Empty: