Media Credentials

I am requesting the following media credentials (please check all that apply):
ReporterPhotographerNewspaperMagazineTelevisionRadioOnlineOther

Name of Org./Affiliate *

Point of Contact *

Title

Street Address *

City *

State *
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Zip *

Country *

Daytime Phone *

Evening Phone *

Email *

List names of all persons attending and their positions.
(Use ONE form for all persons from same media outlet)

Which show/or shows will you be covering
(please check all that apply):
Thursday, June 21st (Performer Interviews)Friday, June 22nd (Media Practice Show)Saturday, June 23rdSunday, June 24th

So that we can help you obtain the coverage that you need, please list any other requests below (Specific interviews, access/footage needed, special story angle, aircraft rides etc.):

Interviews
YesNo

Which acts would you like to interview?

Media Rides?
YesNo

# Requesting Media Rides?
*Media rides are subject to availability and may also be changed or cancelled due to weather or mechanical problems

Access/Footage Needed
YesNo

For which acts would you like access/footage?

Special story lines
YesNo

Please specify.

Special medical needs?
YesNo

Please specify.

If provided with CenterPoint Energy Dayton Air Show credentials, I agree to provide proof that I am at least 18 years old (unless age requirement waived by an authorized representative) and provide my organization's press credentials or an official assignment letter from a bona fide media outlet. We will notify you by e-mail to confirm your credentials as well as provide you with show updates.

I understand and comply with the conditions listed on this form for receiving credentials. *
YesNo