EmailMe Form - "Your Life Arizona" segment planner

Company name *
Do we need your company's public phone number, address, and cross streets? *
Yes
No
Public company phone number *
### - ### - ####
Company address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Cross streets *
Company website *
Point of contact for segment planning
Contact name *
First Last
Contact title *
Contact email *
Contact direct phone number *
### - ### - ####
On-air guest(s)
Guest name *
First Last
Guest title *
Do you have another speaking guest? *
Yes
No
Second guest name *
First Last
Second guest title *
On-screen information (The website you list will be on azfamily.com's Seen on TV page, as well.)
On-screen website *
On-screen phone number *
### - ### - ####
Social media handles
Please use full links. (You'll get an error if you don't.)
X (formerly known as Twitter)
Facebook
YouTube
Instagram
Pinterest
TikTok
Other
Segment information
The producers and editors will use the information you include here to create your unique "Your Life Arizona" segment.
Shoot date *
MM / DD / YYYY HH : MM AM/PM
Please include start time.
Air date
MM / DD / YYYY
If you're not sure, that's fine.
Are we shooting in the studio or on location? *
On location
In studio
Zoom (or other video call)
Zoom info *
Shoot address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Talking point 1 *
Must be between 0 and 200 words, currently: 0.
Talking point 2 *
Must be between 0 and 200 words, currently: 0.
Talking point 3 *
Must be between 0 and 200 words, currently: 0.
Any specific questions you would like the host to ask during your YLAZ segment? *
Must be between 0 and 200 words, currently: 0.
Notes for the producers and editors. *
If you have specific requests like when to show photos or videos, please include them here. (For example: Please show photos 1-3 during first talking point or question.)
Must be between 0 and 200 words, currently: 0.
Please describe props that will displayed or discussed. *
If you have specific requests like when to show photos or videos, please include them here. (For example: Please show photos 1-3 during first talking point or question.)
Must be between 0 and 150 words, currently: 0.
Segment special offer *
Must be between 0 and 150 words, currently: 0.
Just a couple of more questions.
What is the most important result you hope to gain from your appearance on the show? *
Must be between 0 and 150 words, currently: 0.
Is there anything else we should know that is unique to your company, business, etc.? *
Must be between 0 and 150 words, currently: 0.
Who is your sales rep? *
Upload files or share links
File Upload

Add File

If your files are larger than a total of 10MB and you do not have cloud storage available, we can provide you with a solution. If you have files to share from a cloud service like Dropbox or Google Drive, please include them below.
Link to files 1
Link to files 2
Link to files 3
Link to files 4
Link to files 5
One more thing
Terms and Conditions *
I agree to the Terms and Conditions
By submitting a photograph or video (the "Work") through this web page, you irrevocably grant to Gray Media Group, Inc., its licensees, and assigns (collectively, “Company”) a non-exclusive, perpetual, payment-free, residual-free, and royalty-free world-wide, all-media license to use all or any portion of the Work, and also to distribute, reproduce, modify, adapt, display, sublicense, and incorporate all or any portion of the Work into other projects, postings, news story, article, communication or other works created by Company (“Company Created Materials”) and to use the Work in any medium or format or through any other technical process whether now known or hereafter devised and to use the Work in any promotion, advertising, or marketing of Company Created Materials. You expressly release Company from any and all claims arising out of the use of the Work by Company, including but not limited to claims for blurring, distortion, or editing. You also agree to waive any equitable remedies against Company for its use of the Work. You are over the age of 18. If the Work depicts a minor, you either (1) are the custodial parent or legal guardian of all minors depicted in the Work, or (2) have permission to submit the video from the custodial parent or legal guardian of all minors depicted in the Work. You have read Gray Media Group, Inc.'s Standard Terms and Conditions at http://gray.tv/terms.pdf and Privacy Policy and agree to those terms in full.