Modulo di accredito stampa MARCIALONGA 2004

www.federnuoto.it
Media accreditation
INTERNAZIONALI DI NUOTO / 51° SETTECOLLI
13th - 15th June 2014 - ROMA
Mr
Mrs
Name
Surname
Country
Date of birth
Private address
Tel. n.
Fax n.
Mobile
e-mail
Media
Daily Newspaper
Press Agency
Magazine
Internet Website
Radio
TV
Photo Agency
Freelance
Journalist
Photographer
TV Commentator
Radio Commentator
Technician
Other
Name of the company
Business address
Function
Professional card
AIPS number
(type & number)
(If applicable)
Need the press center
yes
no
The Press Center will be equipped with wireless connection
I agree to the treatment of my personal details above provided, with reference to the Italian DLG No. 196/2003.
Date_____________________
Signature________________________
Please, send this form by mail to: [email protected]
Deadline 8th June 2014
Press Office:
Italian Swimming Federation tel. +39 06 36200444-3-2 e-mail: [email protected]