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Personal Information
Name*		Name of Media*
Designation		Press Card No.*
Address		City
State		Country*
Pin/Zip Code		E-mail*
Website		Tel
Fax		Mobile*
Media Information
Frequency		Position
	Daily		Print Journalist
	Weekly		TV Journalist
	Bi-Weekly		Radio Journalist
	Monthly		Online Journalist
	Quarterly		Agency
	Bi-Annual		Photographer
	Annual		Radio Crew
	Agency		Freelancer
			Other
Profile/Work Published Link to the Applicants Name on News Website