2012 Patty Kazmaier Memorial Award Media Credential Request Form

Note: Please submit all credential requests no later than Friday, March 9, 2012. A separate request must be filled out for each person attending. Seats are available for working media only.

1) Contact Information

First name:
Last name:
Media outlet:
E-mail address:
Cell phone number:
Approving editor/manager's name:
Approving editor/manager's e-mail address:
Approving editor/manager's phone number:

2) Media Category

Please only request a credential if you plan to attend the brunch, as there are a limited number of media seats available.

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