Date of Birth

Place of birth

Nationality  *

Passport number

Permanent office address (if different from your organization’s headquarters)

Tel

Fax

Email

Name of the orginization  *

Contact person or Title

Headquarter Address in India

Tel

Fax

Email  *

Other (Please Specify)

Type of medium (check as many as necessary) Daily newspaper   Photo/visual   Television  News agency/service  Radio  Weekly publication 

Position Cameraperson  Director  Photographer  Reporter  Correspondent  Editor  Producer  Technician 

Working Language (s) of your media organization

Your main news topic (s) or field of coverage