HARD COPY REQUEST FORM
Print this page, fill it out, and fax or mail your order to Media Affairs
Director, Church of Scientology International. Please include your
return address and a telephone number where you can be reached, should
further data be needed.
TO: Media Affairs Director
Church of Scientology International
6331 Hollywood Blvd, Suite 1200
Los Angeles, California 90028
(323) 960-3500
(323) 960-3508 or 960-3509 Fax
e-mail: publicrelations@scientology.net
FROM:
Name: ________________________________________
Title: _______________________________________
Organization: ________________________________
Phone number: ________________________________
Fax: _________________________________________
E-Mail: ______________________________________
Years in this capacity:_______________________
Any previous work as journalist:
Company/Firm: Title/Position: Years in this position:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Other personnel references:
Name: Firm: Position:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Would you like to be put a list to receive recent press releases?
Yes: ________ No: _________
References you wish to order, as mentioned in the Scientology Press Office:
----------------------------------------------------------+-----------
QTY.| DESCRIPTION
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------
| | |
----+-----------------------------------------+-----------+-----------