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Media Accreditation Form

 

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MEDIA ACCREDITATION FORM

Name:_________________________________________________________________________________

NIN:___________________________________________________________________________________

Nationality:______________________________________________________________________________

Agency/News Organisation:_________________________________________________________________

Print          Radio       Television           Photography

Contact Address:_________________________________________________________________________

______________________________________________________________________________________

Telephone No:__________________________________________________________________________

Mobile No:______________________________________________________________________________

Fax No:________________________________________________________________________________

Email:__________________________________________________________________________________

Date: ____________________________        Signature:_________________________________________