President of the Republic of Poland / For the Media / Interview Request Form

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Interview Request Form

Name of the broadcaster/publication *

Interviewer *

Contact person *

Phone no. *

Mobile *

E-mail *

www address of the broadcaster/publication *

Country *

Press *

Radio (recorded) *

Radio (live) *

TV (recorded) *

TV (live) *

Language of the interview *

Photographer present *

Main subject of the interview *

Individual issues *

Suggested duration *

Suggested date of the interview *

Planned date/hour of publication *

Additional information *

* - required fields