Media Credentials Application – Non-Member

Media Credentials Application - Non-Member

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

First Name *

Last Name *

Email *

Your Position *

Reporter
Photographer
Director
Editor
Producer
Cameraperson
Technician
Student

Organization *

Website

Type of Organization *

TV
Daily Newspaper
Weekly Newspaper
Radio
News Agency
Online Only
Photo

I/My Organization Belongs To *

Florida Association of Broadcasters
Florida Press Association
Florida Public Broadcasting (The Association of Public Media in Florida)
None of the Above

All credentialed media will receive a parking pass for regular car parking. Please indicate below only if you need space for an oversized satellite truck/van

I need a parking space for a satellite truck

Yes – Van
Yes - Oversized/Truck
No

Media Organization Information

Supervisor Name

Supervisor Phone

Supervisor Email

Address

City

State

Zip / Post Code

Phone

Supporting Documentation

Upload a letter of assignment on official letterhead of a media organization signed by the Publisher/Assignment Editor, Editor-in-chief or Bureau Chief, specifying the name and functional title of the journalist. Unsigned letters or e-mails will not be accepted.

Letter of Assignment *

Upload a photocopy of a valid press card/work pass.

Press Card/Work Pass *

Terms of Acceptance and Signature

I verify that the above information is correct and that I have read and will submit the required supporting credentials as defined in the Media Accreditation Requirements available on www.beforeyouvote.org. You must show a photo ID to pick up your credentials.

Electronic Signature *

Please type your First and Last Name

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. *

2016-08-31