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Media Accreditation Form
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Type of Media
Radio
Television
Print
Online (Blog, VLog, Webcast, etc.)
Other:
Clear selection
Name of Media Outlet
Your answer
Address
Your answer
Suite/Floor
Your answer
City
Your answer
Province / State
Your answer
Phone
Your answer
Media Website
Your answer
Circulation / Viewership
Use only numbers
Your answer
Reach / Region
(e.g. Toronto, New York, Italy, Global, etc.)
Your answer
Please indicate the primary focus of your intended coverage
Technology
Business
Art
Education
Events
Other:
Please indicate which event you are likely to attend
Maker Extravaganza (August 1 and 2)
Maker Festival Satellite Events
Maker Festival Launch Party (July 23)
Clear selection
If you intend to attend a satellite event, please advise which event you are interested in.
A schedule of the satellite events can be found here:
http://makerfestival.ca/satellite-events-2015/
Your answer
On-Site Representative
Please identify who will be the primary representative on-site for your media outlet.
Name
Your answer
Job Title
Your answer
Email Address
Your answer
Phone Number
Your answer
Number of Media Passes Required
1
2
3
4
5+
Clear selection
Comments?
If there is anything you'd like to add, please include it in the box below.
Your answer
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