Media Accreditation Form

Please submit this form before September 3, 2003.

Media are strongly encouraged to take advantage of Lanier Canoe 2003 official accommodations packages, which will include transportation between Gainesville and Hartsfield International Airport and between the competition venue and the lodging facilities.

Type of Media Organization
Press Agency Magazine Newspaper
Photographic Agency Photographer Freelance / Other
Radio Television Online
If description is "Other" or "Freelance", please describe in the box

Credential Information
Full Name of Person Being Accredited:
AIPS Number / Press Card Number:
Please Specify: Journalist Photographer Broadcast Crew
Name of Media Being Represented:
Position(s) Held:
Postal Address:
 
Telephone Number and Code:
Fax Number and Code:
Cellular Phone Number:
Email Address:
Date of Birth:
Place of Birth:
Name of Editor Authorizing Request:

Please specify any special requests:

Please submit a passport-sized color photo as a .JPG or .GIF file here:

Lanier Canoe 2003 reserves the right to revoke media credentials at its discretion.

Lanier Canoe 2003 Media Relations
Tel: (404) 724-2516 / (404) 724-2511
Fax: (404) 874-6545 attn: Randall Kirsch
e-mail: rkirsch@jacksonspalding.com / eobrien@jacksonspalding.com