2019 Media Accreditation Form
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2019 Media Accreditation Form
Coverage Type—Check all that apply:
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Media Type - Check all that apply
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Circulation (or # of listeners, viewers, hits, etc.)
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Your reports will be in:
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Have you covered VAFF before?
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Do you receive VAFF’s email media releases?
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Can we bring any particular story angles to your attention?
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Type of Coverage Planned—Describe story angles sought and/or coverage planned
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Requests for Screeners:
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Media Company (if freelance, attach list of all assigning media. Max 2 per media outlet):
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First Name
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Last Name
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Title or Role (Writer, Photographer, Radio Host, Editor, Blogger, Vlogger, etc.):
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Section or Program Name:
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Work Address: (Unit,Street,City, Province)
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Phone # (Direct) or (Office Main):
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Mobile #:
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Company Website:
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Assignment Editor's Name:
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Assignment Editor's Phone #:
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Assignment Editor’s Email:
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Please write your name (signature)
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Please note:
Number of daily responses
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