Publication Interview Form

Name of Publication:*

Readership (approx. how many):

Name of Interviewer:*

Which CPYR Guest/Author:

Topic for interview/Book(s) to be covered:

Questions to be asked during Interview:

Interview Date requested:*

Duration of interview:*

Approx. Publish date:

Time requested:

Contact Person:*

Phone Number:*

Email:*

Publication address:*

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