Report Back on Local Media Coverage

Thanks for taking a few moments to report back on local media coverage.

*Your Name (*=Required)

*E-mail

Your Street Address

City

State or Province

*ZIP or Postal Code

Phone

Be sure to fill this out once for every story you saw (so if you have 3 stories to report, fill this form out and click submit 3 separate times).

Please answer as many of the following questions as possible. Leave others blank.

What was your role at the Speak Out? Coordinator Speaker Attendee

Type of coverage: TV Radio Print

Date of Story: (be sure to use this format: mm/dd/yyyy — other formats will result in an error)

Time (if radio or TV):

Outlet:
For TV stations, please put both the call letters and the channel, if you can (e.g. WKXE channel 2)

Story Name:

Reporter Name:

Link to story:

Brief description or cut and paste text:

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