Third World Media Network

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Membership Form


Full Name:
Name of Media Organisation:

Type of Media Organisation:
Daily Newspaper    Weekly Magazine    Periodicals 
Web Magazine    Television    Radio 

Your Designation:
Street Address (1):
Street Address (2):
City:
State (where applicable):
Country:
Office E-mail Address:
Web Site Address:
Personal E-mail Address:
Insert Your Photograph:
  
{All fields are required. Your application will not be processed unless you fill out all the checkboxes}

Member Countries
  Bangladesh
  B�nin
  Burkina Faso
  Cambodia
  Ethiopia
  Guin�a
  Haiti
  Ivory Coast
  Laos
  Madagascar
  Malawi
  Mali
  Nepal
  Senegal
  Zambia
  Zimbabwe



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