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 * ReporterPhotographerDirectorEditorProducerCamerapersonTechnicianStudent Organization * Website Type of Organization * TVDaily NewspaperWeekly NewspaperRadioNews AgencyOnline OnlyPhoto I/My Organization Belongs To * Florida Association of BroadcastersFlorida Press AssociationFlorida 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 – VanYes - Oversized/TruckNo Media Organization Information Supervisor Name Supervisor Phone Supervisor Email Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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