2015 one event national media pass application form

2015 ONE EVENT NATIONAL MEDIA PASS APPLICATION FORM
Dea r Appl i ca nt,
To a s sure proper processing of your request, please be s ure to fill in the whole form (below), a ttach a
l etter of referral from the media’s editor i n chief and samples of pres s ma teri a l fea turi ng the FIM
Worl d Championship events (pdf format is preferred). Applications must be received by no later than
2 weeks before the event at the contacts of the local organizer’s press coordinator.
Furthermore, pl ea s e note the fol l owi ng poi nts :
• The Media Pass will be released at the Organizer’s discretion. Approbations will be notified via
e-ma i l .
• The va l i di ty of the Medi a Pa s s i s of the s i ngl e event wri tten on the pa s s .
• Hol der of the Medi a Pa s s mus t be ol der tha n 18 yea rs ol d.
• The Media Pass does not ca rry the right to film without Youthstream’s a uthorisation. For more
deta i l s conta ct Ms Cha rl otte Appa ru, Youths trea m’s TV Genera l Ma na ger, a t
c.a ppa ru@youths trea m.org.
• The holder of the Media Pass a grees to a bide by the rules, conditions and limitations i mpos ed
by Youths trea m a nd CMS/FIM to ens ure the proper a nd s a fe runni ng of the event.
• The designated holder of the Media Pass waives a ll ri ghts and titles to any legal cl a i m a ri s i ng
from a ny a cci dent or da ma ge ca us ed i n conjuncti on wi th thei r pres ence a t the event.
• Youthstream is the owner of the Media Pass, and ha ve the ri ght to wi thdra w i t a t a ny ti me
wi thout previ ous noti ce.
• The us e of the Media Pa ss is governed by the pass conditions boards displayed a t the va ri ous
entra nces to the tra ck area. To enter the tra ck, the designated holder must wear a bib or ves t.
• The Media Pass must be presented i n conjuncti on wi th va l i d i denti fi ca ti on pa pers upon
reques t.
• The gra nting of the Media Pass does not exempt the bearer from local laws a nd regul a ti ons .
• Hol ders of the Media pas s wi l l ha ve to send the material published on the Grand Prix where
they have been accredited (pdf format is preferred) to Ms Samanta Gelli, Youthstream Medi a
Offi cer, to s .gel l i @youths trea m.org.
• Hol ders of the Medi a pa s s who ha ve a l s o been a ccredi ted to fi l m wi l l ha ve to send the
material produced in the Grand Prix where they have been accredited i n a vi deo forma t
rea dable on Ma c a nd pc to Ms Cha rl otte Appa ru, Youths trea m’s TV Genera l Ma na ger, to
c.a ppa ru@youths trea m.org.
• The Media Pass can only be used by the designated holder who acknowledges and accepts
the above conditions, and commits himself/herself to comply strictly with them.
We tha nk you in advance for your cooperation and understanding. Our goal is to issue Media Pa s s es
to professionals only. This way we ca n ensure a professional working environment, and avoid a ny kind
of a bus e.
Bes t rega rds ,
Youths trea m Medi a Depa rtment
RETURN TO: YOUTHSTREAM MEDIA OFFICER Ms. Samanta Gelli
Mobile: +33 6 88340024 ● E-mail: s.gelli@youthstream.org
2015 ONE EVENT NATIONAL MEDIA PASS APPLICATION FORM
1. MEDIA
MEDIA NAME:
ADDRESS:
COUNTRY:
STREET:
CITY:
PHONE:
POST CODE:
+
COUNTRY:
FAX: +
(with area code)
(with area code)
E-MAIL:
WEB:
NEWSPAPER
PUBLICATION:
MAGAZINE
RADIO
ONLINE MAGAZINE
WEBSITE
NEWS AGENCY
TV PROGRAM
TV STATION
TYPE:
GENERAL
SPORTS
MOTORSPORTS
BIKES
COVERAGE:
INTERNATIONAL
NATIONAL
REGIONAL
LOCAL
DAILY
WEEKLY
BI-WEEKLY
MONTHLY
PHOTO AGENCY
OTHER
OTHER
(selling area)
FREQUENCY:
ISSUES PER YEAR:
CIRCULATION:
READERS PER YEAR:
FULL NAME:
EDITOR IN CHIEF
OTHER
EMAIL
PHONE (with area code)
+
PUBLISHING GROUP NAME
WEBSITE
2. JOURNALIST
NAME:
SURNAME:
CATEGORY:
JOURNALIST
PHOTOGRAPHER
CAMERAMAN
TV TECHNICIAN
DAY
MONTH
OTHER
STREET:
POST CODE:
+
COUNTRY:
MOBILE: +
(with area code)
FAX:
RADIO TECHNICIAN
NATIONALITY:
CITY:
PHONE:
RADIO REPORTER
YEAR
BIRTH DATE:
ADDRESS:
JOU/PH
(with area code)
+
E-MAIL:
(with area code)
PREFERRED MAILING ADDRESS:
PROFESSIONAL
PERSONAL
IMPA MEMBER:
YES
NO
3. ADDITIONAL INFORMATIONS FOR AGENCIES AND FREELANCE JOURNALISTS
Publications supplied with text/photos/videos. Specify: name, type, coverage, frequency, circulation, editor in
chief, publishing group HERE
-
RETURN TO: YOUTHSTREAM MEDIA OFFICER Ms. Samanta Gelli
Mobile: +33 6 88340024 ● E-mail: s.gelli@youthstream.org
2015 ONE EVENT NATIONAL MEDIA PASS APPLICATION FORM
-
RETURN TO: YOUTHSTREAM MEDIA OFFICER Ms. Samanta Gelli
Mobile: +33 6 88340024 ● E-mail: s.gelli@youthstream.org