Free Representative Want Ad

Date Submitted:

Media Property: *

Company Name: *

Contact Name: *

Contact Title: *

Address: *

Country:

Company Name: *

Phone Number: *

Fax Number:*

Email Address:*

Website:

Year Founded:

Launch Date if a Start-Up:

Market:

Business to BusinessConsumerInternationalInternet

Media Type:*

EventMobileNewsletterPrintSocialWebOther

Indicate 'Other', if checked:

Media Frequency

Average Circulation / Audience Distribution: *

Audited:

NoYes

If yes, auditing firm?

Method of Circulation:

PaidQualifiedNon-qualifiedOther

Print: 4 Page Color Rate (1x gross)

Digital CPM

Digital Fixed

Other (specify printing):

Audience Profile (all media and events):

Geographic Area for Representation:*

Desired Area of Expertise for Representation:*

How did you hear about NAPR?*