Media Survey

Name:

Address:

City:

State:

Zip:

Email:

Phone:

Do you currently use a content provider?
Yes No

Do you need a feature news release to fill special sections or holes?
Yes No

What would your time frame be before your next space to fill?
< Month 2-3 Months 4-6 Months 6-12 Months

What topics(s) might you be working on?

Charity
Environment
Government
Issues

Receive special offer information from your local NAPS representative?
Yes No

Receive information about services from NAPS?
Yes No