Media Request

Media FOrm

* Indicates required field

Today's Date (MM/DD/YYYY): *

Target Publication Date (MM/DD/YYYY): *

Organization Name *

Contact Name *

First

Last

Contact Email *

Where would you like MDA to promote your materials?
Please allow MDA adequate time for approving materials and processing.

Promotional Needs *

Send an Email Blast (1 week) Share on Facebook (72 hours) Share on LinkedIn (72 hours) Share on Twitter (72 hours) Share on YouTube Channel (1 week) Include in MDA Newsletter (by 25th of the month)

Please describe your marketing materials, including project deadlines, quantities, delivery specifications, and other notes below (you may copy and paste your social media text here):

Project Description: *

Link to your materials (if applicable, e.g., Google Doc/Drive) *

Please upload high quality flyer, image, logo, or Word Doc (Acceptable formats are JPEG, PNG, PDF, DOC):

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

I am an authorized agent and we give MDA consent to move forward with my complete media submission. I have obtained necessary permissions to allow MDA to use photo of someone, copyright materials, and/or private/public contact information: *

I give MDA consent.

Submit

Media Form

Media FOrm