The Accreditation Form

Journalists interested in media coverage of consultations (Tri-City, 9 November 2009) are kindly requested to fill in on-line accreditation form at https://press.kprm.gov.pl until Monday, 2 November 2009 until 8:00 pm (GMT + 1) the latest.

Fields marked with an asterisk (*) are required

• Name *
• Surname *
• PESEL No or passport No * for correspondents
• Father’s first name *
• Media Organisation *
• Country *
• Media Organisation Address *
• Press Card Number *
• Telephone *
• Fax
• Email *
• As for legitimization, I have attached one of following documents (no accreditation without legitimization): *
  
• a copy of my valid press card JPG, PNG, PDF
• or
  a letter of confirmation signed by the chief editor JPG, PNG, PDF
• Type of profession: tick the relevant box TV Journalist Press Journalist Radio Journalist Photographer Cameraperson Sound Engineer Producer Vehicle engineer Other
• Brand and number of the Outside Broadcasting Van (OBV)
• Statement *
  
  After having aquatinted with the content of the above form I do hereby express my consent to process my personal data provided therein, according to the provisions set forth in the Law on personal data protection dated 29.08.1997 ( (J. of L. No 133, item 883), by the Government Information Centre seated at the Chancellery of the Chairman of the Council of the Prime Minister, 00-583 Warsaw, Al. Ujazdowskie 1/3, in order to complete the journalists’ accreditation procedure. Personal data provided herein shall be rendered available to the entities cooperating in the organization of the event. The participants thereto have the right to access their personal data in order to amend or change them.
  Providing the above personal data is voluntary; however, it is necessary to meet all the formal requirements related to the participation in the visit. YesNo