EmailMe Form - 2016 Pensacola Comic Convention™ Press/ Media Pass

Name *

First Last

Address *

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

Phone: *

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

Cell Phone: If no cell enter home phone *

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

Email *

News / Media / Guest Type:
Click all that Apply: *

Organization /Media Outlet: *

Interests:
Click all that apply: *

Number of badges requested: *

1 badge

2 badges

Please indicate who they will be used for (example 2 needed 1 for the reporter and 1 for the camera guy) *

Bio: (Additional Infomation)

Website: *

Twitter: *

Facebook: *

Approximate Coverage reach: *

Would you like to speak or do a panel or presentation? if so what topic .. (or type NO) *

How did you hear about the convention? *

Media credentials are reserved for working members of the media only. This includes
editors, reporters, producers, camera crews, and still photographers. Employees of
media outlets who do not work in an editorial capacity are not qualified for a media
badge.
We reserve the right to modify this policy without public notice and to
revoke accreditation at any time.

Approved Media will receive:

* 1 media pass * (Unless more have been Approved) Additional Passes can be purchased online or at the door

Pensacola Fair Grounds Conference Center
6655 Mobile Hwy Pensacola, FL 32526

Phone:
(850) 941 4321

The convention is to be covered as:

Pensacola Comic Convention™ (Pensacola Comic Con™)

http://www.pensacolacomiccon.com

#pensacolacomiccon #pensacolacomicconvention

Twitter https://www.twitter.com/pensacolacomic

Facebook https://www.facebook.com/pensacolacomicconvention

Please help us spread the word via your Press Releases, Emails, Newsletters, Facebook, Twitter, and other Social Media.

MORE Banners, Logos, and Media Pictures can be found here! http://www.pensacolacomiccon.com/sharewithbanners.htm

*Promotion is required on social media and other marketing arenas!

*PLEASE ADD our BANNER to your SITE and CALENDERS!!

Waiver:
I do hereby represent that:

1. I am 18 years of age or older unless approved by legal parent or guardian with signature below.

2. I recognize and appreciate any dangers and risks inherent in covering festival events.

3. I am submitting this release and waiver of liability declaration voluntarily and of my own free will.

4. I have no physical or emotional problems, nor any history thereof, which will impair my ability to cover for this event.

5. I hold harmless and agree to indemnify Pensacola Para Con Comic Convention, Pensacola Comic Convention, and Pensacola Comic Convention LLC. its officers, directors, employees, agents and volunteers from all claims, liability, and damages I may sustain from any bodily injury, personal injury or property damage which may occur from any cause, including negligence, before, during or after any event in which I participate as a volunteer.

6. I irrevocably grant Pensacola Para Con Comic Convention, Pensacola Comic Convention, and Pensacola Comic Convention LLC, and its agents, the exclusive right to use my name, likeness, photos or reproduction for any purpose including promotion, advertising or other purposes.

7. I acknowledge that I have read and understand this entire Waiver of Liability and Release, and I agree to be legally bound by it.I agree to provide (Pensacola Comic Convention) management with a print or electronic copy of my report, article, segment or podcast about (Pensacola Comic Convention), including any interviews conducted and any photographs used in the final product, for the (Pensacola Comic Convention) archives. I understand that (Pensacola Comic Convention) is NOT requesting editorial privilege and that (Pensacola Comic Convention) will request permission before reprinting or rebroadcasting the material you provide to us in any publication or electronic venue under our control. If you provide us with a link to your online publication or show, we will be glad to publish the link on the (Pensacola Comic Convention) website and cross promote your coverage.

Signature:

First Last

Waiver: I do hereby represent that:

Waiver:
I do hereby represent that: