Media Stay Request Form

Title *

First Name *

Last Name *

Email Address *

Country *

Position e.g. Editor, Journalist *

Name of Publication *

Medium e.g. Print, Broadcast *

Publication Frequency *

Publication Circulation or Broadcast Figures *

Readership Audience Profile *

Aprox. No of Words and Images or Broadcast Minutes *

Expected Coverage Date *

Story Angle *

Requested Hotel *

Approximate Arrival and Departure Times *

Date of Arrival *

Date of Departure *

Special Request

Basis of Stay *

Paradise Road The Villa Bentota

MOHOTTI WALAUWA
138/18 – 138/22 Galle Road
Bentota
Sri Lanka
F +94 34 494 6796