KCTV Speaking Engagement Request Form

Speaking Engagement Request

If you would like a KCTV5 employee to speak at your event, please complete the form below.Please submit at least one month prior to your event if possible.
KCTV5 Personality Requested
Second Choice
Third Choice
Requesting Organization
Are you a 501(c)(3) nonprofit organization?
Event Information
Desired Role (emcee, speaker, judge, etc.)
Expected Crowd Size
Event Date

MonthDayYear
Date
Time of Arrival For Personality

Hour Minutes

AM/PM Option
Event Address

Venue Name

Street Address

CityState

Zip Code
Directions to Event
Phone where KCTV5 personality can be reached at the event:
Please enter a valid phone number.Format: (000) 000-0000.
If a speech is required, will you provide one?
Is a meal being served?
Does the event have political or product affiliations?
How will the event be publicized?
Your Name

First NameLast Name
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Email Address
example@example.com
Terms and Conditions
You have read Gray Local Media, Inc.'s Standard Terms and Conditions at https://graymedia.com/about/terms-of-use and agree to those terms in full.
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