AIM Media Request Form
Thank you for desiring to come to Cambodia and collect media at our programs. Please fill out this form so we can get started on scheduling your shoots and making your trip a success.
Email address *
Your full name *
Your answer
Your website and/or portfolio *
Your answer
Is there anyone else traveling with you? If so, what are their names? *
Your answer
What are the dates you will be collecting media with AIM in Cambodia? *
Your answer
What excites you about AIM's programs and mission? *
Your answer
What are you hoping to create (documentary, photo series, short video, other) as a result of your time collecting media with AIM? *
Your answer
How will this piece be distributed? *
Your answer
What photos/video are you hoping to get in Cambodia when with AIM? *
Your answer
Would you like to interview program participants, or staff? If so, who would you like to interview? *
Your answer
Would you like any interviews or B-roll that AIM may have already collected? If so, what footage or interviews? *
Your answer
Do you know a staff member at AIM that can provide a referral for you? If so, please add their name below. *
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Agape International Missions.