University of Miami Coral Gables, FL 33146 Phone: 305-284-5500 CREDENTIAL REQUEST FORM FOR THE GLOBAL BUSINESS FORUM January 15 - 16, 2009 Please complete this form and e-mail it to ummedia@miami.edu or fax it to 305-2842035 by January 7, 2009. Include a copy of your press identification with photo or a written authorization on the letterhead of the media outlet you are representing. Credentials can be issued only after this information is received. For questions about credentialing please contact Barbara Gutierrez at bgutierrez@miami.edu or 305-2843205 or Jeff Heebner at jheebner@miami.edu or 305-284-4005. 1. Please type or write legibly the following information: Name_______________________________________________ Name of Media Organization_____________________________ Name of Editor/News Director____________________________ Address_____________________________________________________________ City____________________ State_____ Zip _________ Country_______________ Phone Number______________________ Mobile Number ____________________ E-Mail Address___________________________ Fax Number_________________ 2. 3. 4 Please check the box that best describes your outlet: Print (newspaper) Radio (local) Print (magazine) Radio (syndicated) Print (wire/syndicated) Photographer (newspaper) ** Television (local) Photographer (magazine) ** Television (national) Photographer (wire/syndicated) ** Television (international) Internet site Please check the box that best describes your function: Camera / Technical Crew Reporter (Television) Still Photographer Reporter (Radio) Producer (Television) Reporter (Internet) Reporter (Print) Other:_____________ How can we best contact you? Please check the appropriate box: E-mail Fax Telephone 5. The University of Miami will provide wireless access in the media filing center at no cost. There is a nominal fee for media outlets requesting the following services, please indicate if your coverage will require: Ethernet connection $10 Phone line $25 Both $30 None needed for my coverage 6. For Television: Will you be broadcasting live from the University of Miami grounds? If yes, by what means? Satellite Fiber Microwave **NOTE: Various venues across the University of Miami Coral Gables campus will be used for the Global Business Forum. An updated schedule will be sent to registered media by January 9, 2009. Visit www.bus.miami.edu/gbf for more information on the Forum. **NOTE TO TV CREWS: Live stand-ups will NOT be permitted inside the venues during the keynote or panel sessions. Designated on-campus areas will be provided for this.