EmailMe Form - WVSSAC Super Six Football Media Registration-2015

Media Company Name *

Primary Contact Person *

First Last

Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Contact Phone Number *

### - ### - ####

Phone Number Type

Cell Phone

Work Phone

Home Phone

Email *

Confirm Email

Email Type

Work

Personal

Type of Media *

Newspaper

Radio

Television

Yearbook, etc...

If Newspaper, do you require a set in the press box if one is available?

Yes

No

Date Arriving *

MM / DD / YYYY

Games Attending (Check all the apply) *

AA Game (Friday Evening)

AAA Game (Saturday Afternoon)

A Game (Saturday Evening)

Newspapers Only - Number of Pressbox Passes (Please Note: Only One Seat Per Newspaper is allowed)

Number Sideline Passes

Do you require information about lodging for your stay? *

Yes

No

Please attempt to list the names of all persons attending and what type of pass they will require and what game (you can also upload a Word, Excel, or PDF document of this list) *

File Upload

Will you be attending the Media Kickoff Dinner on Thursday evening? *

Yes

No

If attending Thursday Kickoff Dinner please list the names of each person.