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Media Credential Request Form

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:
* Zip:
Country:

*Which race/races will you be covering(Please check all that apply
Allentown, Tuesday, June 3, 2008
Reading, Thursday, June 5, 2008
Philadelphia, Sunday, June 8, 2008
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.

Saturday, July 19, 2008

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