<p>Finger Lakes Media Hosting Request Form</p><p>Thank you for your interest in visiting the Finger Lakes region. In order for us to best assist you, please fill out the following information.</p><p>Name …………………………………… Gender (please circle or bold): Male or Female </p><p>Allergies/Dietary Restrictions______Preferred Level of Activity: High or Moderate or Low </p><p>Birthday______</p><p>Phone Number______</p><p>Website ______</p><p>Email ______</p><p>Social Media Handles______</p><p>Media Organization ______</p><p>Media Organization Address ______</p><p>Type of Media (Print, Blog, Radio, etc.) ______</p><p>Media Outlet Circulation/Monthly Readership______</p><p>Are you currently on a media assignment?______</p><p>Membership or accreditations to professional organizations ______</p><p>Last three travel stories published:</p><p>Destination ______Date______Publication ______</p><p>Destination ______Date______Publication ______</p><p>Destination ______Date______Publication ______</p><p>Areas of Interest (Please Circle or Bold All That Apply)</p><p>Arts/Culture/History Outdoor Recreation Culinary Family travel </p><p>Shopping Wine Golf Scenic Drives</p><p>Water Activities Festivals and Fairs</p><p>1 Desired Arrival Date ______Desired Departure Date______</p><p>Preferred Airport (Please Circle or Bold): Rochester or Syracuse or Ithaca</p><p>Desired Method of Transportation to the Region (car rental, your own car, etc.)______</p><p>Preferred Method of Travel While in the Region (drive yourself or be driven around)______</p><p>Will anyone be joining you? If so, how many? ______</p><p>What types of activities or attractions are you interested in? ______</p><p>Type of Lodging Requested (Camping, Hotel, B&B, etc.) ______</p><p>Room Preference (non-smoking, double, queen, etc.) ______</p><p>Number of Rooms Requested ______</p><p>Projected Date of Publication ______</p><p>I have read the Finger Lakes Tourism Promotion Agencies media hosting guidelines. I meet the qualifications and understand the guidelines.</p><p>Name ______Date ______</p><p>Signature ______</p><p>2</p>