Accreditation form

PERSONAL DATA
Name:
Date of birth (dd-mm-yyyy): Place of birth:
Nationality: Passport number:
Permanent address:
Tel.: Fax: E-mail:
Contact address during the event:
Tel.: Fax: E-mail:
 
DATA ON THE MEDIA ORGANIZATION YOU REPRESENT
Name of organization:
Contact person and title:
Headquarters’ mailing address:
Tel.: Fax: E-mail:
Status/Ownership:
Educational/Public
Government/State
Private
Other (specify):
Type of medium (mark as many as necessary):
Daily newspaper
Photo/visual
Television
News agency/service
Radio
Weekly publication
Other (specify):
Position:
Cameraperson
Director
Photographer
Reporter
Correspondent
Editor
Producer
Technician
Other (specify):
Working language(s) of your media organization:
Your main news topic(s) or field(s) of coverage (if applicable):
Your areas of Interest:
I plan to cover the entire event Szczecin YES NO
I would like access to the official Media Boat YES NO
I would like access to the official Media Plane YES NO
I would like access to the main Parade of Sail YES NO
I will not be attending the event in Szczecin, but I’m interested in receiving all media releases during the event via FAX- E-Mail
Applications should be reach us by July 15 sending by via Post, E-Mail or FAX.

    


Szczecin Municipal Government Office, Plac Armii Krajowej 1, 70-456 Szczecin, phone/fax +48 91 42 45 992 | All Right Reserved | regaty@um.szczecin.pl