DATA OF THE EDITORIAL OFFICE
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name
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address
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telephone
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e-mail
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website
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contact person
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DATA OF ACCREDITED MEDIA REPRESENTATIVE
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media representative #1
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name and surname
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date of birth
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nationality
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passport number (for non-Polish citizens) *
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PESEL number and a father’s name (for Polish citizens) *
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official ID card number (for polish citizens)
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passport/ID Expiration DATE
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e-mail address
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Telephone number
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TITLE (please select one)
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journalist
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cameraman
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photojournalist
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vehicle information
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car pass (please select one)**
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requested / not requested
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car registration number
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type of media (please highlight all applicable)
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press
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radio
| television | internet portal |
please add any additional information below: |
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