NAME:	E-MAIL:
TELEPHONE:	COMPANY:
DO YOU HAVE A 300 DPI JPEG HEAD SHOT PHOTO?	DO YOU HAVE BOTH A CURRENT SHORT AND LONG BIO?
YES  NO	YES  NO
PAST PUBLIC RELATIONS ACTIVITIES:
AWARDS RECEIVED:
INTERVIEWS GIVEN (LIST MEDIA AND DATES):
DO YOU ENJOY PUBLIC SPEAKING?
YES  NO
POSSIBLE SPEAKING TOPICS:
DO YOU OR DOES YOUR FIRM PRODUCE A NEWSLETTER?
YES  NO
IF YES, HOW OFTEN?
DO YOU ENJOY WRITING ARTICLES?
YES  NO
POSSIBLE ARTICLE TOPICS:
DO YOU ENJOY HOSTING SOCIAL EVENTS?
YES  NO
IF YES, WHAT TYPE?
DOES YOUR SPOUSE OR SIGNIFICANT OTHER ENJOY HOSTING SOCIAL EVENTS?
YES  NO

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(Select One) Larry Kohn Bob Kohn Wendy Brickman Jeffrey Miiller Harriett Greenbaum Diane Rumbaugh