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Media Accreditatiom Renewal Form

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MEDIA ACCREDITATION RENEWAL FORM

(All renewal forms MUST be submitted at least one month before pass expiry date)

 

Name:____________________________________________________________________

 

Agency/News Organisation:___________________________________________________

 

Print         Radio       Television          Photography

Pass Number:_____________________________________________________________

Date of Issue:_____________________________________________________________

Date of Expiry:____________________________________________________________

Contact Address:__________________________________________________________

________________________________________________________________________

Telephone No:____________________________________________________________

Mobile No:________________________________________________________________

Fax No:__________________________________________________________________

Email:___________________________________________________________________

Date: ________________________  Signature:_________________________________