Interview

Email Blast Request Form

Please note that the information you type will be the information that appears on the postcards and in the email blast. Please double check spelling, times, dates, and contact information!

Your Email Address:

If entering more than one, ensure they're in the same order!	Dates (as Day of Week, Month DD)	Times (as h:mm - h:mm am/pm)

Location Name:
Street Address:
City, State, Zip:
Comments that should appear on the email/postcard

Your Name:

Below, please list the contact information of who will be taking the questions about this program.

Contact Name:
Contact Phone:
Contact Email:

Notify students in the following area:

State
State and City
Zip Range
Alumni Club Code
County

Below, please list the contact information of who will be taking the questions about this program.

Notify students in the following area:

Notes for Brian or Jess