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Roundtable Interest Form
Please fill out our interest form if you would like to attend our roundtable and be on the lookout for further details regarding the event.
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* Indicates required question
Email
*
Your email
Business Name
*
Your answer
Name of your show or program
*
Your answer
Name of Host, Producer or Editor
Your answer
Contact Number
*
Your answer
Type of Media Outlet
*
YouTube Show
Podcast
Facebook Show
Blog
Newsletter
Radio
Discord Channel
Other:
Required
Tell us about your media outlet
*
Your answer
Reason for attending meeting
*
I'd like to attend. I already know I want to join the collective.
I would like to speak at the meeting. I would like to share some of my ideas and perspectives.
I'd like to attend just to get more information
Other:
Required
Website
Your answer
Facebook Fanpage URL
Your answer
Twitter URL
Your answer
Instagram URL
Your answer
YouTube Channel URL
Your answer
Podcast URL
Your answer
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