Media Accreditation Form

MEDIA ACCREDITATION FORM Thank you for your interest in the 2012 Playhouse Wine Festival. All media interested in being accredited for this year’s Festival are required to complete the form below. Please note that passes to Festival events will be provided to working media only. Accreditation will be given to reporters, freelancers, editors, videographers and producers. Advertising, sales and marketing, and administrative staff are not considered working media and will not be accredited. *REQUIRED FIELDS

MEDIA OUTLET INFORMATION

Media Outlet^*

Address^*

City^*

Province / State

Postal / Zip Code^*

Country

Main Phone^*

Outlet Category

Category (ie. Newspaper, magazine, television, website, blog, other)^*

Circulation or Viewership (Web contributors and/or editors please provide traffic statistics such as number of unique visits per week)^*

CONTACT INFO

First Name^*

Last Name^*

Title (If freelance please indicate) ^*

E-mail^*

Mobile (If you are interested in receiving last minute updates on event/seat openings please leave your mobile numer)

EVENT REQUESTS
Indicate below the Festival events you would like to attend in order of importance. ** Due to the large volume of requests please only choose those events that you will be available to attend. **

**PLEASE NOTE MEDIA PASSES ARE NOT AVAILABLE FOR GOLD PASS. BACCHANALIA ACCREDITATION IS ONLY GRANTED TO THE RECEPTION PORTION OF THE EVENING. KINDLY SPECIFY EVENTS OF INTEREST. APPLICATIONS NOTING A GENERAL CATEGORY SUCH AS "DINNERS" OR "DAY-TIME" WILL NOT BE CONSIDERED.**

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