Accreditation form

Medium

Title of medium

Kind of media

Function

Professional Address

Address Medium

Postcode/Town

Country

Telephone

Fax

Person to be accreditated

Name

Surname

Mobile

Email

Press ID card

Number

Picture (jpg < 150Kb)

Working place required

yes
no

Lodging

yes
no

Hotel category

Kind of board

Date of arrival

dd/mm/yyyy

Date of departure

dd/mm/yyyy