MEDIA REGISTRATION FORM
Name of Company: ________________________________________________
Company Website: ________________________________________________
Type of Company (TV, Magazine, Web, etc.) ___________________________
Name: ___________________________ E-Mail: _______________________
Phone ___________________________ Fax: __________________________
Mailing Address: __________________________________________________
What type of equipment will you be using?______________________________
Number of Passes Needed: _______________
Names of Staff Members: 1. ______________________ 2. __________________
3. ______________________ 4. __________________
By completing & signing this form, you agree to participate in the 2010 YGEA Awards Ceremony. You will be allocated 2 passes. Additional passes will be distributed at $15 p/pass. You accept that your reserved location will be set by the Media Coordinator and agree that your company will pick up media passes one week prior to event. You will be contacted on the whereabouts to pick up your passes. In the event that you are late for your set up, contact the coordinator for alternative arrangements.
You also agree that you will release footage of what you tape (audio & video) and/or write up in a magazine within two weeks after the event. We appreciate your cooperation and participation.
Authorized Printed Name: _______________________________________
Authorized Signature: ___________________________________________
Title: _____________________________ Date: _____________________
Please send in this form as soon as possible so you will be assigned a location. Deadline for Media Registration is September 15, 2009. Email form to:
. Or mail to address below.
2462 Feathertree Lane, Suite A
Lawrenceville, GA 30044
Attn: Media Registration
"Entertainment With a Purpose"
Phone: 678.266.0727 | Email: email@example.com Copyright © 2009. YGEA Awards, Inc. All Rights Reserved.
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