2015 ONE EVENT NATIONAL MEDIA PASS APPLICATION FORM Dea r Appl i ca nt, To a s sure proper processing of your request, please be s ure to fill in the whole form (below), a ttach a l etter of referral from the media’s editor i n chief and samples of pres s ma teri a l fea turi ng the FIM Worl d Championship events (pdf format is preferred). Applications must be received by no later than 2 weeks before the event at the contacts of the local organizer’s press coordinator. Furthermore, pl ea s e note the fol l owi ng poi nts : • The Media Pass will be released at the Organizer’s discretion. Approbations will be notified via e-ma i l . • The va l i di ty of the Medi a Pa s s i s of the s i ngl e event wri tten on the pa s s . • Hol der of the Medi a Pa s s mus t be ol der tha n 18 yea rs ol d. • The Media Pass does not ca rry the right to film without Youthstream’s a uthorisation. For more deta i l s conta ct Ms Cha rl otte Appa ru, Youths trea m’s TV Genera l Ma na ger, a t c.a ppa ru@youths trea m.org. • The holder of the Media Pass a grees to a bide by the rules, conditions and limitations i mpos ed by Youths trea m a nd CMS/FIM to ens ure the proper a nd s a fe runni ng of the event. • The designated holder of the Media Pass waives a ll ri ghts and titles to any legal cl a i m a ri s i ng from a ny a cci dent or da ma ge ca us ed i n conjuncti on wi th thei r pres ence a t the event. • Youthstream is the owner of the Media Pass, and ha ve the ri ght to wi thdra w i t a t a ny ti me wi thout previ ous noti ce. • The us e of the Media Pa ss is governed by the pass conditions boards displayed a t the va ri ous entra nces to the tra ck area. To enter the tra ck, the designated holder must wear a bib or ves t. • The Media Pass must be presented i n conjuncti on wi th va l i d i denti fi ca ti on pa pers upon reques t. • The gra nting of the Media Pass does not exempt the bearer from local laws a nd regul a ti ons . • Hol ders of the Media pas s wi l l ha ve to send the material published on the Grand Prix where they have been accredited (pdf format is preferred) to Ms Samanta Gelli, Youthstream Medi a Offi cer, to s .gel l i @youths trea m.org. • Hol ders of the Medi a pa s s who ha ve a l s o been a ccredi ted to fi l m wi l l ha ve to send the material produced in the Grand Prix where they have been accredited i n a vi deo forma t rea dable on Ma c a nd pc to Ms Cha rl otte Appa ru, Youths trea m’s TV Genera l Ma na ger, to c.a ppa ru@youths trea m.org. • The Media Pass can only be used by the designated holder who acknowledges and accepts the above conditions, and commits himself/herself to comply strictly with them. We tha nk you in advance for your cooperation and understanding. Our goal is to issue Media Pa s s es to professionals only. This way we ca n ensure a professional working environment, and avoid a ny kind of a bus e. Bes t rega rds , Youths trea m Medi a Depa rtment RETURN TO: YOUTHSTREAM MEDIA OFFICER Ms. Samanta Gelli Mobile: +33 6 88340024 ● E-mail: [email protected] 2015 ONE EVENT NATIONAL MEDIA PASS APPLICATION FORM 1. MEDIA MEDIA NAME: ADDRESS: COUNTRY: STREET: CITY: PHONE: POST CODE: + COUNTRY: FAX: + (with area code) (with area code) E-MAIL: WEB: NEWSPAPER PUBLICATION: MAGAZINE RADIO ONLINE MAGAZINE WEBSITE NEWS AGENCY TV PROGRAM TV STATION TYPE: GENERAL SPORTS MOTORSPORTS BIKES COVERAGE: INTERNATIONAL NATIONAL REGIONAL LOCAL DAILY WEEKLY BI-WEEKLY MONTHLY PHOTO AGENCY OTHER OTHER (selling area) FREQUENCY: ISSUES PER YEAR: CIRCULATION: READERS PER YEAR: FULL NAME: EDITOR IN CHIEF OTHER EMAIL PHONE (with area code) + PUBLISHING GROUP NAME WEBSITE 2. JOURNALIST NAME: SURNAME: CATEGORY: JOURNALIST PHOTOGRAPHER CAMERAMAN TV TECHNICIAN DAY MONTH OTHER STREET: POST CODE: + COUNTRY: MOBILE: + (with area code) FAX: RADIO TECHNICIAN NATIONALITY: CITY: PHONE: RADIO REPORTER YEAR BIRTH DATE: ADDRESS: JOU/PH (with area code) + E-MAIL: (with area code) PREFERRED MAILING ADDRESS: PROFESSIONAL PERSONAL IMPA MEMBER: YES NO 3. ADDITIONAL INFORMATIONS FOR AGENCIES AND FREELANCE JOURNALISTS Publications supplied with text/photos/videos. Specify: name, type, coverage, frequency, circulation, editor in chief, publishing group HERE - RETURN TO: YOUTHSTREAM MEDIA OFFICER Ms. Samanta Gelli Mobile: +33 6 88340024 ● E-mail: [email protected] 2015 ONE EVENT NATIONAL MEDIA PASS APPLICATION FORM - RETURN TO: YOUTHSTREAM MEDIA OFFICER Ms. Samanta Gelli Mobile: +33 6 88340024 ● E-mail: [email protected]
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