Consultation Form/ Wait List
Everything shared through this consultation form will be held strictly confidential. Unless you, (the addressee) authorizes to use, copy, or disclose any of this information. If you received this form in error, please advise the sender by reply email at PubliSISGrind@gmail.com. This information is used to have a clear understanding of the brand that is inquiring about P.R. services with PubliSIS Grind.

Consultation call will take about 15 mins.
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Email *
Name *
Phone number *
Birth date
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Your brand/company's name *
What is your brand/company’s product, service, or objective? *
What is your brand/company’s focus? *
Industry (ex. Health & Beauty)
On a scale of 1 to 5, 1 being the least and 5 being the most, how familiar are you with the Public Relations industry or the duties of a publicist? (Will provide additional information if not too familiar.) *
Judgement-free zone.
Nothing
Very familiar
What P.R. Services are you interested in? *
Required
If we move forward with services, our PR packages start at $750 per month, (our other services have different pricing). Payment plan options are available. Would investing $50 to start be a stretch for you? *
Names and positions of authoritative personnel.
List the people we may have to work or talk with within your company
Any images you would like to share?
What is your company’s website address?
How did you hear about Publicist | Yahne’ Jackson? *
By SUBMITTING THIS FORM, you agree to the following:1) I agree to consult with Publicist | Yahne’ Jackson. 2) I understand that the Publicist does not guarantee responses from Media personnel if chosen as a service. 3) I understand the importance of being transparent with the publicist. 4) I understand that there may be additional adjustments according to changing circumstances of partnering personnel (which include but not limited to: media staff, property owners, crisis breaks etc). 5) I understand that it is my responsibility to inform the publicist of any concern I may feel during the time period of business so he/she may adjust accordingly. 6) I understand that I or the Publicist may terminate the session at any time, may things become unsafe. 7) I have been given a chance to ask questions about the session and my questions have been answered. 8) I agree to adhere to all safety and professional behaviors at all times. 9) I fully understand that at no time will a refund of my deposit be issued and further understand that a credit maybe issued at the owners discretion. 10) I give my permission for this information to be used for business purposes only, within approval. *
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