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Information about your magazine * Name of the magazine     * Address   * Zip code   * City   * Country   * Phone   * Fax   * Email         * Media   Television Radio Agency Public magazine Professional press       * Name of the chief editor         * Edition   copies * Periodicity

Information on the journalist * Name * First name   Address   * Zip code      * City      * Country      * Phone   * Fax   * Email                     * Position   Manager    Chief editor Department head Section editor Journalist Freelance journalist Correspondent Photographer   Assistant Advertising manager Other:

Description of the film unit Number of persons   Names   Description of the broadcast or   the report   Positions   Date distribution