2012 CHCI HHM Media Credentials Form

CONTACT INFORMATION

Name:

Title:

Media Organization/Company:

Editorial Contact:

Mailing Address:

Phone #:

Fax #:

Cell #:

E-mail:

MEDIA OUTLET SPECIFICS

Publication/Outlet:

Circulation/Viewership/Market Ranking:

On Assignment:

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

Yes No

Please select the events you are interested in covering:

Public Policy Conference:

Yes No

Reyes of Comedy:

Yes No

Gala Red Carpet:

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:

Title:

Name:

Title:

Name:

Title:

Enter the characters as they appear in the box to the right *

* Required

CHCI will notify you the week of September 3, 2012, 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.