Registration for Interview Report

Name*

Show / Program name*

Station call letter

Station Address

City

State

Zip code / postal code

Country*

Phone

Your Website(s)* (e.g. https://Israel120.com) Please include “https://” or “http://” in your website URL.

Email address (must be a professional address)*

What types of topics do you prefer to interview Nathanael-Israel Israel for?

Date of the interview (specify the time zone)

Your budget (how much you will pay us) for this interview*

Is the interview live or taped?

Is it in person or over the telephone?

Is it an interview alone or with others?

Will listeners phone in?

What is the length of the interview?

Other comments