Media Credentials Application

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Name*

Organization*

Title

Phone

Email*

Street*

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Please describe your audience size and demographic

If you attended last year, please describe your coverage

Type

Quantity

Full Name(s) - Please separate multiple names with a semicolon.

Print Reporter

TV/Radio Personality

Online Reporter

Photographer

Still Photographer

Total Requests

Please summarize your coverage plans for Celebrity Fight Night XXV, (include pre-event coverage)

Additional Notes