Accreditations - Madeira Press: The Rali Vinho Madeira Organisation asks for all local press to send their accreditation requests before the 26th of July. For that purpose, this form must be used.

Media Accreditation Application

Deadline for Applications: Saturday 26th of July 2008
Fields marked with * are required

PERSONAL DETAILS
First Name:			Surname:
Function:	Journalist     Photographer     Journalist/Photographer
Home Address:
City:			Country:
Home Phone:			Home Fax:
Home Email:
Enter the mobile number where you want free SMS messages to be sent. Please make sure you prefix the number with a '+' and enter your phone number in international format, which is country code followed by the mobile number (omitting the first '0' in the mobile number).
Mobile Number:
Photo:

ORGANISATION
Name of Media Body:
Postal Address:
City:			Country:
Work Phone:			Work Fax:
Work Email:
I shall be working and covering the event for: (please tick)
FIA/RPA Journalist   News/Photo Agency   Trade Press Rep Freelance   TV   Photographer Radio - International   Reporter   Technical Crew (for Media from Madeira only) Electronic Media   Magazine   Newspaper Other: (please specify)
Circulation (average number of copies or audience):
Agreed Name Company Signature Date I confirm that the information in this form is correct.

Rally Vinho Madeira reserves the right to accept or reject any application for media accreditation.