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Submit a Media Pass Application
Contact Details
First Name
*
Last Name
*
Email
*
Mobile Phone
*
Home Phone
Emergency Contact Details
Emergency Phone Number
*
Emergency Contact First Name
*
Emergency Contact Last Name
*
Medical Conditions
*
Media Information
Media Category
*
Photography
Internet/Blog
Magazine
Newspaper
Radio
Video/Documentary
TV
Please select which category best describes your intended media activity for this event
Organisation
If you work for a media organisation, please enter the name of the organisation here.
Photo
Please upload a photo of yourself. Please note the uploaded image must be of the applicant - applications with random images will not be accepted.
Add a new file
*
Files must be less than
5 MB
.
Allowed file types:
png gif jpg jpeg
.
Images must be at least
500x500
pixels. Images larger than
4000x4000
pixels will be resized.
Facebook Link
*
URL
*
Please enter your Facebook Page URL - it should be in the format of http://www.facebook.com/yourprofilename or http://www.facebook.com/pages/yourprofilename/1234567890
Website
*
URL
*
Please enter your Website URL - it should be in the format http://www.yourwebsite.com
Number of viewers/circulation
If you work for a digital or physical publication, enter the number of viewers/circulation here.
Description of intended media activity
*
Any comments / questions / suggestions ?
Vertical Tabs
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