Media Organization Information

Name of Media Organization (required)

Name of Program/Column (required)

Type of media: (check all applicable) :
JournalRadioOnlineTelevisionMagazine

Frequency of Publication / Broadcast:
DailyWeeklyMonthly

Access Required (check all applicable):
TV TruckFinish LineStart Line

Language of media (check all applicable):
EnglishFrenchOther
Other Languages :

Expected Air Date/Publication Date:

Contact Person

First Name(required)

Last Name(required)

Title (required)

Address (required)

City(required)

Postal Code (required)

Telephone (required)

Ext

Email (required)

Accreditation Request

Parent or Associated Media Company (if applicable)

Indicate the number of accreditations requested: