|
Tell us
about you and your organization
|
|
First
and Last Name :
|
|
|
Position
:
|
|
|
Email :
|
|
|
Phone
Number :
|
|
|
Name
of the Organization:
|
|
|
Type of organization (store, hospital,
publication, etc) :
|
|
|
For
Profit
Non-for-Profit
|
|
Address
:
|
|
|
City
/ State / Postal Code :
|
|
|
Country
:
|
|
|
Material
and Information Being Requested
|
|
What
are you requesting? (copyright release of pictures or
content, interview, etc)
|
|
|
Brief
description of the purpose for the request :
(i.e., presentation, website, publication, TV Program, etc) :
|
|
|
Who
is the target audience? :
|
|
|
Do
you or your organization currently use the Zaky? and if
so, who uses them and how many do they use?
|
|
|
When
will you use the material requested and for how long?
|
|
|
When do you need the
requested material from us (date)?
|
|
|
Would
you send Zakeez, Inc. a copy of the publication/
presentation/tape/etc to be included in our website and marketing/education
materials? :
|
|
| Is
there something else that you want to tell us? |
|
