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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
Company Name
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4
Job Title
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5
Phone Number
Area Code
Phone Number
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6
Media, Publication, or Organization Name
*
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7
Do you represent an industry organization or community group?
Yes
No
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8
What forms of media do you produce?
*
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Select all that apply
Online journal
Online magazine
Print journal
Print magazine
Blog
Podcast
Email newsletter
Other educational content (ie webindars)
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9
Please describe your target general audience or membership
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10
What is your publication or organization's website?
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11
What is your publication's average number of website visits per month?
*
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12
What is your publication's email list size
*
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13
What is your publication's aggregate social media reach?
*
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14
Media Twitter Handle
*
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15
Media Facebook
*
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16
Media LinkedIn
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17
Have you attended Flourish before?
*
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2017
2018
2019
I have not attended Flourish before
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18
How did you hear about Flourish
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19
Please verify that you are human
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