Media Accreditation Form

2010 Canada Army Run Media Accreditation Form for Canada Army Run and Associated Events

Name of Media Organization:
Name of Program/Column:

Type of media: Frequency of Publication (check all applicable):

Access Required (check all applicable):

	TV Truck		Finish Line
	Start Line		Media Room

Language of media (check all applicable):

English

French

Other

Expected Air Date/Publication Date:

First Name:	Last Name:	Title:
Address:	City:	Postal Code:
Telephone:	ext.:	Fax:
Email:	Parent or Associated Media Company (if applicable):

Indicate the number of accreditations requested:

Media Contact Informationon Race Day:
Velma LeBlanc, 613-794-4806 or media@armyrun.ca