Company Registration Form

Candidate Nominee Company Information:

Company Sponsoring Advertising

Name of Advertising or Promotional Campaign

Submitting Company
(if different from advertising sponsor)

Primary Contact Information (for individual submitting entry):

Name^* Name is a required field

Company

Telephone

Email^* Email is a required field Email is invalid; Email must be valid

Company Contact Information (for entering company):

Company Name

Name of (check one):

Name^* Name is a required field

Mailing Address^* Address is a required field

City^* City is a required field

State^* - Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennesse Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State is a required field

Zip Code^* Zip Code is a required field Zip Code is invalid; Zip Code must be valid

Country

Telephone

Email^* Email is a required field Email is invalid; Email must be valid

Briefly Describe the Advertising or Campaign.

Target Audience

Name of Advertising or Promotional Campaign

Media used

Date of Publication or Broadcast

Brief Description of Components/Material

Sample Material

Sample Material Description

Describe why this Campaign should be considered for Positively Print recognition.

Explain how this campaign promotes including Print in the media mix to retain or add to print volume.