press credential application

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Outlet Category *

Print

TV

Radio

Digital

Photographer (if applicable)

First Name

Last Name

Photographer Phone (if applicable)

(###)

###

####

Camera Crew Contact (if applicable)

First Name

Last Name

Camera Crew Phone (if applicable)

(###)

###

####

News Van Access Required?

Yes

No

Anchor's Name (if applicable)

First Name

Last Name

Anchor's Phone (if applicable)

(###)

###

####

Giveaway / Contest Tickets Requested? *

Yes

No

Applicant Signature *

Please provide your full name below, accepted as your digital signature.

First Name

Last Name

Date of Signature *

MM

DD

YYYY