Media Press Credential Agreement - The All-American Koi Show

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Name of person requesting credential:

First

Last

Title of person requesting credential:

Media Organization:

Email Address:

Phone Number:

Website / URL

Social Media Handles:

If you are representing a person or a company, please indicate below. If not applicable, please write 'N/A'.

credential: person Signing

Signing date:

Sign with your Initials Here :

By signing and submitting this form, I understand that my request has been submitted for review.