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2014 CHCI HHM Media Credentials Form


1.  CONTACT INFORMATION 
 

Name:

 
 
2.  Title: 
 
3.  Media Organization/Company: 
 
4.  Editorial Contact: 
 
5.  Mailing Address: 
 
6.  Phone #: 
 
7.  Cell #: 
 
8.  E-mail: 
 
9.  Circulation/Viewership/Market Ranking: 
 
10.  Please select the events you are interested in covering: Public Policy Conference 
  Yes   No
11.  Reyes of Comedy: 
  Yes   No
12.  Gala: 
  Yes   No
13.  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.

 
 
14.  CREDENTIALS REQUESTED 
 

Total number of media credentials requested:

 
 
15.  Name: 
 
16.  Title: 
 
17.  Name: 
 
18.  Title: 
 
19.  Name: 
 
20.  Title: 
 
 
Enter the characters
as they appear in
the box to the right *  
Validation Image
  * Required


You will be notified you the week of September 22, 2014, if your credentials are accepted. If you have any questions, please contact Scott Gunderson Rosa, Director of PR & Media at (202) 548-5876 or via email at sgrosa@chci.org.

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