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MEDIA ASSESSMENT FORM
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Please fill in the form in the grey lines.
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Name of the company/media:
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Country:     
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Name:     
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Position:     
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Company address:     
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Phone number:     
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E-mail:     
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Web:     
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Social media:
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Short description of the company/media:
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Publishing frequency:
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Number of copies:     
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Target group of the media:      
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Number of readers/readership:     
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Estimated period of the article publishing:     
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Approximate length of the article:
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Dates of your visit:
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Reason why you are interested in the Czech Republic:
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Places of interests in the Czech Republic / suggested itinerary ideas (for individual journalists):
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Expected support (for individual journalists):
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Special travel requirements (i.e. diet):     
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Presentation opportunity for our partners in the article:
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Example of your recent article (please attache)
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By submitting of this form I agree to the following cancellation policy:
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60 – 31 days before – air ticket price if it has been already issued and paid by CzechTourism
30 - 8 days before - 100 EUR + air ticket price
7 days before and less – 500 EUR + air ticket price
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The cancellation conditions shall not be applied in case of force majeure or serious illness.
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 Date:
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