Title *

First Name*

Last Name*

Phone Number *

Mobile *

Email*

Name of media organisation/publication/channel *

Your job title*

Type of media *

• News Agency/Wire service
• Radio - National
• Radio - Regional
• Radio - Community
• Television
• Television - Film crew
• Photographer - stills
• Newspaper - Weekly
• Newspaper - Daily
• Magazine
• Online newspaper/magazine
• Blog
• Social media
• Freelancer
• Other

Are you going to require accreditation to take photographs in venues?

• No
• Yes

Interests

• Live Performance
• Music
• Youth and Development Programmes
• Family Friendly
• Business of Festivals

Media website address *

Facebook Page*

Twitter handle(s)*

Postal Address *

City *

State/Province *

ZIP / Postal *

Name of Editor/Manager *

Editor/Manager's Phone number *

Date of intended arrival in Winter Fest *

CEOSalesSupport

Motivation *