Media Credential Form

Media Credential Request
State Tournament Event Choice*
Team(s) Covering at Event
Media Outlet Type*
Media Outlet Name*
Sports Editor/Director*
Sports Editor/Director E-mail:*
example@example.com
Sports Editor/Director Phone Number*
Accounts Payable Email:
Media Outlet Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Media member names to be listed on credential(s)
Please review credential eligibility and maximum request limits in the WIAA Media Policies Handbook
Media Member #1

First NameLast Name
Media Member #1 Reporter or Photographer

ReporterPhotographer
Media Member #2

First NameLast Name
Media Member #2 Reporter or Photographer

ReporterPhotographer
Media Member #3

First NameLast Name
Media Member #3 Reporter or Photographer

ReporterPhotographer
Media Member #4

First NameLast Name
Media Member #4 Reporter or Photographer

ReporterPhotographer
Communication Use: Dollar figure represent cost of connect and is independent of rights fees

($25) File Story/Live Reports($25) Cell Phone Live Reports($100) Play-by-Play
Type of connection needed for live reports or play-by-play broadcast?*

WiFiCell Phone DataPhone Line (not accessible at UW facilities)LAN Line ($125) if available at venue
Should be Empty:

Media Credential Request