WRDW Mix at 3 Business Request Form

Mix at 3 Request Form

Interested in being featured on Mix at 3? Tell us a little more about you.
Are you a business or non-profit?
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Description of event or topic*
Type your bio information here.
Segment Topic?
Type a list of props you may need to bring for the segment?
Are you providing graphics and/or video for this segment?

YesNo
Are you providing your company's logo and/or additional graphics, photos or videos? If yes, please submit here:

Browse Files

Cancelof
Is your non-profit a licensed 501(c)(3) (by saying yes, you agree to show documentation if asked)?

YesNo
Consent and Validation *

I certify to the best of my knowledge that this information is accurate.
Please enter your date of birth.*

MonthDayYear
Date
Terms and Conditions

Client and partners 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.
I Agree to the Terms and Conditions
Should be Empty:

Mix at 3 Request Form