JOHN WALLACE

Guest Appearance Request Form

"Not Just Another Pretty Face in Politics!"

Please Fill out the following "Do-it-yourself" Booking Form for JOHN WALLACE to be a Guest on your Radio or TV Show.

If you prefer to schedule by phone, or for a personal appearance at your organization's function, please call: 518-392-7062.

When you are finished. click the Submit button. After we receive your request, we will contact you via email. If you have any additional questions/comments, please include them at the bottom of this form.

Requested Interview or Appearance Date:
Interview Start Time - Hour and Minute:	AM PM
Interview Ending Time - Hour and Minute:	AM PM
Time Zone:
Program Name::
Station or Network:
Broadcast area (i.e. city, state, internet or national):
Who Calls Who?	Guest to call host at Studio #: Host to call guest (We will contact you with guest number if you selected this option.)
Your Main Switchboard Number:
Who do we notify or contact with your guest confirmation:	Name of Contact: Email of Contact: Contact Tel # Contact Fax#
Any Comments, Issues, Questions or Special Instructions you may have: