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Accreditation
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Name/Name/Nom/Apellido:
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Date of Birth/Geburtsdatum/Date de naissance/Fecha de nacimiento:
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Place of Birth/Geburtsort/ Lieu de naissance/Lugar de nacimiento:
Nationality/Staatangeh�rigkeit/ Nationalit�/Nacionalidad:
Passport Number/Pass- oder PA-Nr./N� de passeport ou de carte nationale d�identit�/N�mero de pasaporte/DNI:
issued by/ausgestellt durch/d�livr�(e) par/expedido por:
valid until/g�ltig bis/valide jusqu�au/v�lido hasta:
Press Card Number/Presseausweis-Nr./N� de la carte de presse/N�mero de credencial de prensa:
issued by/ausgestellt durch/d�livr�(e) par/expedido por:
valid until/g�ltig bis/valide jusqu�au/v�lido hasta:
Office Address/B�roadresse/Adresse professionnelle/Domicilio laboral:
Media/Medium/Organe de presse/Medio de prensa:
Country of Media/Land des Mediums/Pays de l�organe de presse/Pa�s del medio de prensa:
Telephone/Telefon/T�l�phone/Tel�fono:
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Fax/T�l�copieur/Fax:
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E-Mail/Courrier �lectronique/Correo electr�nico:
Please mark as applicable/Zutreffendes bitte ankreuzen/Pri�re de cocher la mention correspondante/Marque con una cruz lo que corresponda:
