Interview/shooting application form

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Name (required)

E-mail address (required)

Phone number (required)

Affiliation

Name of publication / TV program

Publication date / airdate

Purpose and means of shooting/interview, object of shooting/interviewee, etc. (required)

Planned date and time of shooting/interview:
　　First choice:　
　　Second choice:　

Number of shooting crew/reporters, equipment, cars, etc.

Other remarks (if any)

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