MEDIA CREDENTIAL REQUEST FORM

DEADLINE IS APRIL 7, 2017
PARKING IS NOT GUARANTEED FOR LATE MEDIA CREDENTIAL REQUEST

Company Name:

Main Contact Name:

Media Type:
Newspaper Television Magazine Internet Other

Address:
City:
State:
Zip Code:
Phone: (example) 909-555-1212
Email:
Person needing credentials
(First & Last Name):
Credential Dates Pass Type
1 All 13 14 15 Reporter Photographer
2 All 13 14 15 Reporter Photographer
3 All 13 14 15 Reporter Photographer
4 All 13 14 15 Reporter Photographer
5 All 13 14 15 Reporter Photographer

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WHEN YOU SUBMIT THIS FORM YOU WILL RETURN TO THE MT. SAC RELAYS MEDIA PAGE

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Mt. SAC Relays - 1100 North Grand Avenue - Walnut,CA 91789
(909) 274-5114 - Fax (909) 468-4416
kwalter@mtsac.edu - http://www.mtsacrelays.com

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