Wniosek akredytacyjny na 4. Tatarak Music Festival 2015. / Press

Wniosek akredytacyjny na 4. Tatarak Music Festival 2015. /
Press and Media Accreditation Form for 4. Tatarak Music Festival 2015.
DANE PERSONALNE / PERSONAL INFO
Imię i nazwisko / Name and Surname:
.................................................................................................................................
Stanowisko / Job Title:
.................................................................................................................................
Numer legitymacji prasowej / Press/Photo ID Number:
.................................................................................................................................
Dane kontaktowe (e-mail: | telefon) / Contact (telephone / email):
.................................................................................................................................
DANE ZAWODOWE / MEDIA INFO Redakcja / Office:
….............................................................................................................................
Pełny adres korespondencyjny (ulica / nr / kod / miasto)
/ Full Office Address (street / office number / post code / city / country):
..................................................................................................................................
…...............................................................................................................................
Dane kontaktowe - Redaktor Prowadzący (e-mail, telefon | adres www)
/ Media Comissioning Editor Contact / (email address, telephone number | www):
...................................................................................................................................
Medium (prosimy o zaznaczenie właściwego) / Medium Channel (please choose the correct one):
PRASA/PRESS | RADIO/RADIO | TV | INTERNET | FOTO/PHOTO Nakład, Liczba słuchaczy / Circulation,
Listenership:
....................................................................................................................................
Data publikacji (prosimy wymienić wszystkie już poczynione oraz daty planowanych emisji materiałów / Coverage
Information (please insert links for all previous and dates to all in preparation):
.....................................................................................................................................
….................................................................................................................................
….................................................................................................................................
Podpis Redaktora Prowadzącego + pieczątka redakcji / Comissioning Editor + Medium stamp
.....................................................................................................................................
Prosimy odesłać mailowo na adres: [email protected] nie później niż do 30 czerwca 2015.
Please send back to: [email protected] no later than June 30st 2015.