I am requesting the following media credentials (please check all that apply. Those fields with an asterisk *, are required):
Reporter	Photographer	Other
Newspaper	Magazine	Television	Radio	Online
Relationship to Media	StaffFreelance

* First Name:
* Last Name:
* Title:
Organization/Affiliate:
* Web Address of Organization/Affiliate:
* Phone:
* After Hours:
Fax Number:
* Email Address:
* Mailing Address:
* City:
* State:	Other Select a State ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FEDERATED STATES OF MICRONESIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA NORTHERN MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
* Zip:
Country:

*Please check the race you will be covering

Philadelphia, Sunday, June 3, 2012

So that we can help you obtain the coverage that you need, please list any other requests below (Specific interviews, access/footage needed, special story angle, phone lines, etc.):

Please list 3 of your most recently published articles/photographs/news footage:

* How would you like to be contacted (please check one): Email Fax

Pro Cycling Tour reserves the right to refuse or revoke media credentials. Thank you for your interest in the Pro Cycling Tour, we look forward to working with you and your staff.