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 (or role within organization/relationship to organization)

  • Guest 2: First Name and Last Name

  • Guest 2: Job Title (or role within organization/relationship to organization)

  • Website of Organization

  • Paragraph about your organization. Please consider 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 5-7 questions your organization wants the host to ask during the interview.

    Indicate which guest is best suited to answer each question. It’s important to rotate questions between the guests to create a ‘conversation.’ No more than two questions in a row directed at one guest.
  • Twitter Handle

  • LinkedIn

  • Facebook

  • Contact Email Address

  • Taping Date

    Date Format: MM slash DD slash YYYY
  • 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: eps, ai, jpg, pdf, png.
  • If you have an upcoming event, please provide the URL to information on your website.

  • If you have photos that could be included in your interview segment, please upload them here. NCTV17 will use photos at our discretion based on content and resolution of images.

    Drop files here or
    Accepted file types: jpg, png, gif, tif.

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