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

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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

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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

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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:

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