Please Attach your Business Card & Your Photo to this Form |
1. First & Middle Name: |
2. Surname: |
3. Gender: Female Male |
4. Marital Status: Single Married |
5. Father's Name: |
6. Date of Birth (DD/MM/YY): |
7. Place of Birth: |
8. Passport Number: |
9. Date of Issue: |
10. Date of Expire: |
11. Place of Issue: |
12. Current Nationality: |
13. The Name of your respected Media: |
14. Nationality of the Media: |
15. Language of the Media: |
16. Your Position: |
17. Top Manager (Name, Position): |
18. Cell Phone: |
19. Website: |
20. ٍEmail Address: |
21. Work Address: |
22. Tel & Code: |
23. Fax & Code: |
24. Phone No. in Tehran: |
25. Field of Study: |
26. Education :
Graduate£Diploma£ Bachelor£ Master£ PhD£Professor£
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27. Spoken Language(S): |
28. Professional Background:
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29. A Brief History of the Media:
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30. Previous Visit to Iran: |
31. Arrival ِDate: |
32. Departure Date: |
Date: Signature:
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کلیه حقوق این پورتال متعلق به وزارت فرهنگ و ارشاد اسلامی میباشد