ACCREDITATION FORM

This service is reserved to media people.

Press service
Uni-d-fox - Karine Devilder
13, Bayens 33570 Puisseguin - France
Tel :+33 (0)5 57 74 50 81 - Fax : + 33 (0)5 57 74 50 82
E-mail : contact@unidfox.com

Company *:
Name *:
First Name* :
Function* :
Address* :
Postal Code *:
City* :
Country* :
Phone* :
Fax :
Mobile :
E-mail* :

Press card number * :

Media's Type * :

	Press agency
	Daily newspaper
	Weekly newspaper
	Monthly
	Photo agency
	Web Site
	Radio
	TV
	Free lance
	Other, specify

TECHNICAL FACILITIES REQUESTED


	Desk in the press center
	Seat in press stand
	with electrics plugs
	Locker
	Photo armband
	Internet connexion ADSL

other request :

Informations given by you are transmitted to the website labaule-cheval.com. You can have a right of access to those informations, change them or modify some of the data (art.34. of the law "informatiques et libertés"). To exercise your right, get in contact with Uni-d-fox, 13 Bayens - 33570 Puisseguin ou contact@unidfox.com

* Requested