Media Credential Request Form--2011 AM

ALEC Media Credential Request Form

I am requesting the following media credentials for ALEC's 2011 Annual Meeting (please check all that apply): *

Relationship to media: *

Staff

Freelance

First Name *

Last Name *

Title

Organization *

Web address of organization/affiliate:

Address of organization/affiliate *

City *

State *

Postal Code *

Work Phone *

Cell Phone

Email Address *

Days Attending: *

Wednesday

Thursday

Friday

So that we can help you obtain the coverage 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: *

Email

Phone

By checking this box, I understand that ALEC general meal sessions, general membership events and workshops are open to the media. Task Force and Subcommittee meetings and events requiring invitations are not open to the press. *

I agree

ALEC reserves the right to refuse or revoke media credentials.

Thank you for your interest in ALEC. We look forward to working with you and your staff!