MEDIA EXPERT PROFILE

The Source. is an expert resource for local, state, and national media. By completing the form below you create a profile to be added in a password-protected, searchable database of experts for journalists looking for experts. As applicable, the information appears with your Forum media packet in abbreviated form. You may also print the form and return via fax at 202-638-1434.

First Name:   Last Name:
Title:
Organization:   Website: http://
Address:
City:  State:   Zip:
Work Phone:  Alt. Phone:
Fax:
Email:
Photo File:

Are you available for Radio interviews? Yes No
Are you available for TV interviews? Yes No
Biography:
Describe yourself, your profession and relevant work experience.


Please indicate area(s) of interest and/or expertise. Please be specific.
This information will aid the media in "keyword" searches of our authors and experts directory. For example: Children’s Health Issues, Reproductive Rights, Welfare Reform, Environmental, etc.


Additional Information:
(Organizations & Affiliations; Publications; Awards)

Board Access Password Application: Board members may apply for a password to enter the Forum's board access area. Please fill out the information below for a password. If you do not wish to sign-up for a password, leave items blank.

Choose your username and password. You will use this to signin in the future. Maximum of 15 characters for either (no spaces are allows).

Username:   Password: