Strong Start Form
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Let Strong Start come to you!

Fill out the form below to invite Tim Strong to broadcast live from your location.

1.Contact Informaton
First Name* M.I. Last Name*

Email Address* Daytime Phone* Evening Phone*
2.Address
Street Line 1
Street Line 2
City
State
Zip Code
3.I'd like to invite Tim to come to ...
Location Name*
Location Address*
Location Address Line 2
Location City*
Contact Person at Location*
Contact Person's Phone Number*
4.Please enter your date of birth.
Month* Day* Year*
5.Terms and Conditions
   YES, I have read, understand, and agree to the Web site usage agreement and privacy policy.
* represents required fields
By submitting this form, I agree that I am inviting News 12 to my business, organization, or other location for a live broadcast on a weekday between the hours of 5 and 7 a.m. I certify that I have the authority to make this invitation.