City of Miami Beach

MEDIA ASSISTANCE/CREDENTIAL REQUEST FORM

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Company Name:
First Name:
Last Name:
Title:
Phone:
Fax:
Skype:
E-mail Address:
Web Address (URL):
Blog (URL):
Twitter:
Facebook:
Scribd:
YouTube:
Other:
Address:
Address Two / Suite:
City:
State/Province:
Country:
Zip Code:
Contact Me By:

  Media Information
Dist/Broadcast Regions:
Languages:
Circulation/Demographics:  
Number of years in business:  
Focus/Publication Date/Comments:  
Events Interested in Covering:  
Technical Requirements to Cover Event (ie, cabling, live truck, etc.):  
Number of crew members: