Media Accreditation - Jackalope 2017
IDENTIFICATION
Statut
First Name
Your answer
Last Name
Your answer
Adress
Your answer
City
Your answer
Province/State
Your answer
Country
Your answer
Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Function
Press Card Organisation
Your answer
Press Card Number
Your answer
MEDIA
Name
Your answer
Type
Service
Your answer
Diffusion
Reach
Your answer
Web Site
Your answer
RESPONSABLE
First Name
Your answer
Last Name
Your answer
Title
Phone
Your answer
Email
Your answer
* Tribu Expérientiel reserves the right to require a letter from the person in charge to validate the accreditation
ATTENDANCE
Days
Required
Topics of interests
Required
Broadcasting date(s)
Your answer
Requests
Your answer
I understand that Tribu Expérientiel is absolved of any responsibility for material breakdowns and incidents as part of its JACKALOPE event.
Required
Thank you for your interest in JACKALOPE. A response to your application for accreditation will be sent shortly.
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