Media Accreditation
Please complete both forms in capital letters, sign and return them by post latest by Wednesday, 29 th October 2014. Please note: This application form does not warrant the issuance of a media pass.
_________________________
Last Name
_________________________
Org./publication/station
_________________________
Post Code
(Org./publication/station)
_________________________
Phone no.
(Org./publication/station)
_________________________
Mobil no.
(Org./publication/station)
_______________________________
First Name
_______________________________
Street address (
Org./publication/station)
_______________________________
City
(Org./publication/station)
_______________________________
Fax no.
(Org./publication/station)
_______________________________
E-Mail address
(Org./publication/station)
I am a/n:
□
□
Editor
Free-lance journalist
□
Editor and Photographer
□
Photographer
Organisation:
□
Daily Newspaper
□
Weekly or other magazine
□
Online-Magazine
□
Agency
□
other business
□
Trade magazine
□
□
□
Ad-journal
Radio
Internet
□
TV
(please apply separately for a permission to film –contact David Clemens, wige MARKETING gmbh,
Am Coloneum 2, D-50829 Köln, Phnoe +49 (0)221 78 87 75 36, Fax +49 (0)221 78 87 75 39, E-Mail
David.Clemens@wige.de
.

Number of copies / no. of viewers or listeners /no. of page impression:
__________________________________________
My order includes the following coverage:
□
ADAC GT Masters
□
Formel ADAC
□
ADAC PROCAR
□
Other ___________________________________
□
Please add my contact details in the ADAC GT Masters media newsletter
mailing list 2014.
Please proof your journalist status by providing
□ a copy of a valid 2014 press card
□ samples of your work in journalism
□
Your official appointment letter (by an editor, agency etc.)
Slovakiaring 08/08/14 – 10/08/14in original
For an media accreditation you have to send minimum two of these criteria.
Contact in case of emergency - essential necessary information !
Name: ________________________________________
Mobil no. ________________________________________
________________________
City, Date
___________________________
Signature