Request a Media Visit
First Name
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Last Name
*
Email
*
Phone Number
*
Street Address
Street Address 2
City
State / Province
Zip Code
Country
Emergency Contact Name
*
Emergency Contact Phone Number
*
Allergies or Restrictions?
Health Concerns / Physical Limitations
Others Attending (if children, include ages)
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Media Outlet Information
Media Outlet(s)
Facebook
Instagram
Other
Audience Profile/Reach
Do you plan to post to social media during your visit?
Yes
No
File Upload (40MB max)
Browse Files
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Please submit media kit, writing examples or any other files you would like to share. (max file size: 40 MB)
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Coverage Information
Have you visited Butler County?
Yes
No
Approximately how long ago?
Why are you a good fit for an Experience Butler County partnership?
Assignment - Yes or No, Please Describe
Lodging Needed?
Yes
No
Lodging - Yes or No, Please Describe
Content Rates
Please list your content rates or attach your rate card to this application.
Content/Media Rate
Upload Rate Card
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Assistance with meals?
Transportation assistance?
Requesting an itinerary?
Requesting a guide/escort?
Places you'd like to visit
Interested in destinations nearby (outside Butler County)?
Other interests / requests
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