APPLICATION FORM FOR PRESS ACCREDITATION

APPLICANT’S
Surname			Name								Nationality
Father’s  Name	Place and Date of Birth								Date and Number of Passport
Job Title £ Representative  £ Bureau Chief   £ Correspondent £ Photographer £ Cameraman £ Technician £ Other ………………………								Permanent Address in Home Country
Home Address in Turkey							Office Address in Turkey
Home Phone		Home Fax				Office Phone				Office Fax
Mobile / Cellular Phone (optional)						E-mail
Length of Stay in Turkey				Date and Number of Residence Permit
Date of Previous Press Card, If Any						Languages Spoken
Occupation and Income Other Than Journalism  in Turkey					Information to be Included in the Press Guide/Web-Site £ Office Address   £ Office Phone £ Office Fax     £ E-Mail   £ Home Address   £ Home Phone    £ Home Fax     £  GSM

MEDIA ORGANISATION^(*)
Name of the Organisation		Address (head office)
Phone +		Fax +
E-mail		Internet Address
Type of Publication or Broadcast £ Wire/News Service £ Newspaper £ Magazine £ TV  £ Radio £ Other  ……………………….			Publication Period (for print media) £ Daily £ Weekly £ Monthly £ Other  …………………….…..
Language of Publication or Broadcast	Circulation/Audience		Distribution / Broadcast Area £ Local    £ National     £ International £ Other  ……………….….…

(*) Other affiliations, if any, should also be mentioned.

PLACE AND DATE OF LAST ENTRY INTO TURKEY …………………

DATE AND SIGNATURE …………………..

Official use only Basın Kartının Tarih ve No’su Süresi

: :

OTHER AFFILIATIONS

1.

Name of the Organisation		Address (head office)
Phone +		Fax +
E-mail		Internet Address
Type of Publication or Broadcast £ Wire/News Service £ Newspaper £ Magazine £ TV  £ Radio £ Other  ……………………….			Publication Period (for print media) £ Daily £ Weekly £ Monthly £ Other  …………………….…..
Language of Publication or Broadcast	Circulation/Audience		Distribution / Broadcast Area £ Local    £ National     £ International £ Other  ……………….….…

2.

Name of the Organisation		Address (head office)
Phone +		Fax +
E-mail		Internet Address
Type of Publication or Broadcast £ Wire/News Service £ Newspaper £ Magazine £ TV  £ Radio £ Other  ……………………….			Publication Period (for print media) £ Daily £ Weekly £ Monthly £ Other  …………………….…..
Language of Publication or Broadcast	Circulation/Audience		Distribution / Broadcast Area £ Local    £ National     £ International £ Other  ……………….….…

3.

Name of the Organisation		Address (head office)
Phone +		Fax +
E-mail		Internet Address
Type of Publication or Broadcast £ Wire/News Service £ Newspaper £ Magazine £ TV  £ Radio £ Other  ……………………….			Publication Period (for print media) £ Daily £ Weekly £ Monthly £ Other  …………………….…..
Language of Publication or Broadcast	Circulation/Audience		Distribution / Broadcast Area £ Local    £ National     £ International £ Other  ……………….….…

4.

Name of the Organisation		Address (head office)
Phone +		Fax +
E-mail		Internet Address
Type of Publication or Broadcast £ Wire/News Service £ Newspaper £ Magazine £ TV  £ Radio £ Other  ……………………….			Publication Period (for print media) £ Daily £ Weekly £ Monthly £ Other  …………………….…..
Language of Publication or Broadcast	Circulation/Audience		Distribution / Broadcast Area £ Local    £ National     £ International £ Other  ……………….….…