Please type the below information EXACTLY as you wish for it to appear in the show.

Please use a desktop or laptop to fill out the form. iPhones and iPads are not compatible to attach your logo to the form.


  • Name of Organization

  • Guest 1: First Name and Last Name

  • Guest 1: Job Title (Staff) or Role/relationship to organization (Non-Staff)

  • Guest 2: First Name and Last Name

  • Guest 2: Job Title (Staff) or Role/relationship to organization (Non-Staff)

  • Website of Organization

  • Approximately 350 words about your organization. This as an opportunity to promote your organization, so include key search words within your description that will help Google find your interview. Click here to see an example of an organization's content.

  • Provide 5-6 questions your organization wants the host to ask during the interview. Indicate which guest will answer each question.

  • Twitter Handle

  • LinkedIn

  • Contact Email Address

  • Upload your large format logo for the show. A large format PDF is preferred. The higher the resolution, the better. A small thumbnail will not work.

    Accepted file types: ai, jpg, pdf, png, jpeg, Max. file size: 50 MB.
  • Upload up to 6 hi-resolution images (at least 300 pixels per inch (ppi)). For use during your interview. Please make sure the images correspond to points you plan to cover in your interview. I.e. If you plan on talking about the grand opening of a new facility, please send images or renderings of the new facility. Photo usage is at NCTV17's discretion.

    Drop files here or
    Accepted file types: jpg, gif, png, pdf, eps, Max. file size: 50 MB, Max. files: 6.

    Please use a desktop or laptop to fill out the form. iPhones and iPads are not compatible to attach your logo to the form.