the COMMS COACH Media Training Enrollment Form

This form is for students who will be attending an upcoming COMMS COACH Media Training workshop.  The information that you provide will help in customizing your workshop.

Real World Media Training Enrollment Form

Workshop Date

Name *

Title *

Company *

Street Address *

Address Continued

City *

State *

Zip *

Years With Company *

Email Address *

Job Responsibility

Educational Background/Job Experience

Past Experience with News Media (Prior interviews with TV/Newspapers - good, bad, indifferent):

Past Media Training, if any. Kind of course/ When:

Your major concerns about facing the News Media/Public:

Your worst media nightmare as it would apply to you and your organization:

What are the three questions you feel would be the most difficult to answer in a crisis situation, if applicable?

What do you hope to get out of this course?