The Media Project HELPline: Request for Information Form

First Name:*

Last Name:*

Company/Show:

Address:*

Address (line 2):

City:*

State:*

       Zip:* 

Phone:

       Fax: 

E-mail:*

Are you a ...?

Type of Project:

Film

Television

Radio

Print

Other:

Service requested:

HELP! I need a story idea!

Script review / story consultation

Referral to experts

Factual information

Materials for set design

Other:

Describe your request.