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2003
adidas Big Time
Media Credential Request Form •••Please Respond by July 2, 2003••• |
| Please use this form for requesting WORKING MEDIA credentials. Please
complete form (print or type) and return it promptly. We
cannot guarantee to honor requests received after July 2, 2003. All The Big Time-approved, credentialed media members must be at least 18 years of age. Credentials will not be mailed. FAXed confirmation will follow requests by July 3, 2003. The event headquarters will be at Green Valley High School where the official The adidas Big Time Media Center will be located. All credentials will be issued at the event Media Center, ID required. |
| Please
return promptly to: Dominic Clark, Local Media Relations Coordinator 2003 The adidas Big Time c/o Image Media 3230 East Flamingo Road, Suite 210 Las Vegas, NV 89121 (702) 735-7123 - FAX (702) 735-8154 |
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| NOTE: If approved, website media outlets will receive a maximum of TWO (2 credentials!) | |
| (Please Type or Print clearly) | |
| Name of Reporter(s): | |
| 1. | 2. |
| 3. | 4. |
| Name of Photographer(s): | |
| 1. | 2. |
| Affiliation: | |
| Address: | |
| City: | |
| State: | Zip: |
| Phone: | FAX: |
| E-Mail: | Web Site: |
Assigning Supervisor:
Signature of Assigning Supervisor: