Media Group- Adding additional journalist(s) to your membership

INFORMATION

Please complete this form in order to add journalists to your MEDIA Group.

MEDIA Group Administrator contact details

Last name(Required)

First name(Required)

Mobile(Required)

International format (example: 32 6 XX XX XX XX)

Phone

International format (example: 33 1 XX XX XX XX)

Email(Required)

Enter email Confirm email

MEDIA Group ID(Required)

MEDIA name

Indicate the NAME of your MEDIA (if applicable)

Address(Required)

Street Address Address Line 2 City Postal Code Country