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2013 HHM Media Credentials Form

CONTACT INFORMATION 

Name:

 
Title: 
Media Organization/Company: 
Editorial Contact: 
Mailing Address: 
Phone #: 
Fax #: 
Cell #: 
E-mail: 
Circulation/Viewership/Market Ranking: 
Please select the events you are interested in covering: 

Public Policy Conference:

 
 Yes   No
MEDIA OUTLET SPECIFICS 

Publication/Outlet:

 
Reyes of Comedy: 
 Yes   No
On Assignment: 

**Credentials will not be issued to freelance writers or photographers that are not on assignment.

 
 Yes   No
Gala: 
 Yes   No
MEDIA COVERAGE 

***Due to limited space for media at CHCI HHM Events we can not guarantee access to all events. Please specify how you plan to cover our events, and when and where you expect it to be published or air.

 
CREDENTIALS REQUESTED 

Total number of media credentials requested:

 
Name: 
Gala Red Carpet: 
 Yes   No
Title: 
Name: 
Title: 
Name: 
Title: 
Enter the characters
as they appear in
the box to the right *  
Validation Image
* Required


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