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    Media Request Form - Google Forms

    Uploaded by

    jayadi hadinata
    This document is a media request form containing questions for media professionals requesting visits to hotels in Bali. The form collects contact details, social media details if applicable, publication details for writers and bloggers, photography/videography details, and visit request specifics. Applicants are asked to provide information like number of followers, average engagement metrics, proposed post schedule and value, and preferred hotel and dates.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Media Request Form - Google Forms

    Uploaded by

    jayadi hadinata
    81 views4 pages
    This document is a media request form containing questions for media professionals requesting visits to hotels in Bali. The form collects contact details, social media details if applicable, publication details for writers and bloggers, photography/videography details, and visit request specifics. Applicants are asked to provide information like number of followers, average engagement metrics, proposed post schedule and value, and preferred hotel and dates.

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    This document is a media request form containing questions for media professionals requesting visits to hotels in Bali. The form collects contact details, social media details if applicable, publication details for writers and bloggers, photography/videography details, and visit request specifics. Applicants are asked to provide information like number of followers, average engagement metrics, proposed post schedule and value, and preferred hotel and dates.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    81 views4 pages

    Media Request Form - Google Forms

    Uploaded by

    jayadi hadinata
    This document is a media request form containing questions for media professionals requesting visits to hotels in Bali. The form collects contact details, social media details if applicable, publication details for writers and bloggers, photography/videography details, and visit request specifics. Applicants are asked to provide information like number of followers, average engagement metrics, proposed post schedule and value, and preferred hotel and dates.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    12/19/2018 Media Request Form

    Media Request Form


    PERSONAL DETAILS

    * Required

    1. Email address *

    2. Surname (as written on passport) *

    3. Given name/s (as written on passport) *

    4. Nationality *

    5. Contact Number *

    6. Dietary Requirements / Food Allergies/ Sea


    Sickness *

    7. Number of Pax *

    8. Number of Room *

    9. Select Hotel Name


    Check all that apply.

    AYANA Resort and Spa, BALI


    RIMBA Jimbaran BALI by AYANA
    AYANA Komodo Resort, Waecicu Beach

    https://docs.google.com/forms/d/1mW2nZ8SJS5tXft_jakeJ3jWTu7PMA6X1ZDHv6qF8xzA/edit 1/4
    12/19/2018 Media Request Form
    10. Position/ Title *
    Mark only one oval.

    Influencer/Instagramer/KOL Skip to question 10.


    Editor/Blogger/Media Office-Online Skip to question 18.
    Photographer/Videographer Skip to question 24.
    All the above option

    SOCIAL MEDIA DETAILS


    11. Social Media Account *

    12. Number of Friends/Followers *

    13. Number of Average Likes *

    14. Number of Average Comments *

    15. Number of Posts Offered *

    16. Number of Stories Offered *

    17. Date of Posts / Stories *

    Example: December 15, 2012

    18. Proposed Media Value (in USD) *

    PUBLICATION DETAILS
    19. Publication/Programme/Website *
    Mark only one oval.

    Print
    Online

    20. Detail of Circulation / Audience

    https://docs.google.com/forms/d/1mW2nZ8SJS5tXft_jakeJ3jWTu7PMA6X1ZDHv6qF8xzA/edit 2/4
    12/19/2018 Media Request Form

    21. Distribution Countries

    22. Estimated Coverage (# of page/words)

    23. Date of feature

    Example: December 15, 2012

    24. Proposed Media Value (in USD)

    PHOTOGRAPHY/VIDEOGRAPHY DETAILS
    DELIVERABLE

    25. Social Media Account / Website

    26. Number of Friends/Followers

    27. Portofolio

    28. Number of Image Offered

    29. Number of Video Offered

    30. Date of Post or Images Delivery

    Example: December 15, 2012

    31. Proposed Media Value (in USD)

    VISIT REQUEST DETAILS


    https://docs.google.com/forms/d/1mW2nZ8SJS5tXft_jakeJ3jWTu7PMA6X1ZDHv6qF8xzA/edit 3/4
    12/19/2018 Media Request Form
    32. Requested date(s) of stay OR Visit

    Example: December 15, 2012

    33. Story Angel *


    Mark only one oval.

    Wedding
    Luxury
    Spa
    F&B

    Other:

    34. Previously visited AYANA/RIMBA? *


    Mark only one oval.

    Yes
    No

    35. Persons/specialists to meet, meeting required? *


    Mark only one oval.

    Expert Beauty Therapist


    Wedding Event Planner
    Spa Manager
    Food and Beverage Director

    Other:

    36. Special Requests


    Mark only one oval.

    View Wedding Locations


    View Event/Meeting Venues

    Other:

    Powered by

    https://docs.google.com/forms/d/1mW2nZ8SJS5tXft_jakeJ3jWTu7PMA6X1ZDHv6qF8xzA/edit 4/4

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