Press conference and round table
January 30 12-00
Moscow, Miusskaya Sq. 7, p.1
The application form for accreditation of media journalists
to the event of Association of Assistance to Rett syndrome patients
APPLICATIONS FOR ACCREDITATION
I ask to accredit the following editorial staff to the press conference and a round table that will be be held on January
30 at 12:00 pm in the Civic Chamber of the Russian Federation in Moscow, Miusskaya Sq. 7, p.1:
Last name, first name of the media representatives
Telephone / fax, e-mail address of the journalist
Information about the media:
Full official name of the media
Zip code or address of the media
Business telephone numbers, and fax editors, e-mail
edition
Area of distribution of products
The form of periodical distribution of information
Subjects and (or) specialization
For print media:
periodicity of release
circulation of the media
For electronic media:
broadcast channel
Net broadcasting
For online publications:
site Address
Appendix:
1. A copy of state registration of mass media in the Russian Federation Ministry for Press, Broadcasting and Mass
Communications;
2. A copy of the broadcasting license (for electronic media, performing radio and television broadcasting);
3. The list of equipment for security service.
Editor in Chief ______________________
___________________________________
(first name, last name)
(signature)
Contact:
Irina Solomatina
irenesolomatina@gmail.com
+ 7-903-806-25-29,
+ 7-926-733-42-76