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Media request form

Journalist Information

Travel Dates & Details

*Choose Chicago reserves the right to determine a reasonable amount of nights for a media request, based on stated story focus and length.
*Date of Arrival:	mm/dd/yyyy, if TBD please enter 0
*Date of Departure:	mm/dd/yyyy, if TBD please enter 0

Media Outlet Information

Social Media and Online

Facebook (Personal page) & # of Friends:
Facebook (Publication page) & # of Likes:
Twitter (@personalhandle) & # of Followers:
Twitter (@publicationhandle) & # of Followers:
Pinterest Username & # of Followers:
Instagram Handle & # of Followers:
YouTube Username & # of Views:
SnapChat Username & # Score:
Weibo Username & # of Followers:
WeChat Username & # of Followers:
Youku Username & # of Followers:
Other Platforms: URLs & Stats:

Anticipated Results

What is your Story Focus?:
Publication/air date:	mm/dd/yyyy
Assigning Editor Name:
Assigning Editor Position:
Assigning Editor Email:
Assigning Editor Phone Number:
Letter of assignment:	udf_3421 Yes No
If yes, please attach assignment letter here:
If no letter of assignment, please explain why:
Expected coverage results:
Will you include coverage of host partners?:	udf_3425 Yes No
Will you include Choose Chicago web site? www.choosechicago.com:	udf_3426 Yes No
Anticipated Social Coverage:

Previous Chicago Visits

Have you ever visited Chicago?:	udf_3567 Yes No
Date(s) and Sponsor(s) / Host(s):
Media result(s) from assisted visit(s):

Touring Details

Choose Chicago will review assistance based on the following:

Independent Arrangements:

Requested Accommodations:

# of rooms requested:

# of working media and title(s):

Assistance type:

Complimentary

Media Rate

Other

Requested Products and/or Experiences:

Equipment: List all equipment that will tour around with you, if applicable:

(cameras and type, lighting, sound, etc.)

Dining Preferences:

(Do you prefer to eat outdoors, when feasible?)

Ground Transportation Preferences:

Are there certain modes of transportation that you prefer, Uber vs public transit, etc.

Flight Request

Departure Flight Preference – Date and Time Range:
Return Flight Preference – Date and Time Range:
Preferred Airport for Departure and Return:

Secure Flight Info

To avoid unnecessary delays and prevent misidentifications, passengers must provide complete secure flight data when booking airline travel.

Date of Birth (Month/ Day/ Year):

Known Traveler ID:

Passport #:

Frequent Flyer Airline & Number:

Passport Expiration Date:

Seat Preference:

Middle

Window

Aisle

Place of Issue:

Red fields are required.

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