Africa Unite


- MEDIA ACCREDITATION FORM - SUBMISSIONS DUE NO LATER THAN WED JAN-26-2005
PLEASE COMPLETE THE FOLLOWING FORM ALL FIELDS MUST BE ANSWERED IN ORDER TO SUBMIT THE FORM
	First Name
	Last Name
	Email Address
	Agency Name
	Agency Type	Print Radio Television	Online/Web Technician Journalist
	TRAVEL INFORMATION
	Passport Number
	Arriving Flight Number & Airline Name
	Arriving Flight Date	(MONTH / DAY / YEAR)
	Arriving Flight Time
	Departing Flight Number & Airline Name
	Departing Flight Date	(MONTH / DAY / YEAR)
	Departing Flight Time
	PERSONAL CONTACT INFO
	Street Address
	Apartment / Floor
	City / Province
	State
	Country
	PostalZip
	Phone
	Fax
	EQUIPMENT INFORMATION
	Please provide a detailed list of equipment you are bringing so that we can prepare customs officials.
	ADDITIONALLY, YOU MUST SEND A PHOTO OF YOURSELF TO IGETACHEW@UNICEF.ORG