WIDE Friends in the Media Network

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Registration Form

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1.	In order to register for the Friends in the Media Network, please enter your contact information:

First Name
Last Name
Address
City
Country
Work Phone
Cell Phone
Email Address

2.	Are you a freelance journalist?

Yes No

3.	What publication(s)/ media agency are you working for/ with?

4.	Have you covered gender or development issues in your articles before?

Yes No

5.	What are the main fields of interest you like to write about?