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