(Items in red are required)
Organization:
National Affiliate or Publisher:
Category:	Select One: Magazine Television Newspaper - Daily Newspaper - Non Daily Radio Photographer Commercial Production or Video Other
Circulation, readership, or viewers:
Purpose for covering the event:	Select One: Complete Program Feature News Other
Organization's Email:
Street Address 1 :
Street Address 2:
City:
State:
Zip:
Country:
Country Phone Code (leave blank if United States):
Organization's Phone # (including area code):
Organization's Fax #:
First Name:
Last Name:
Title or Function:
Email:
Direct Phone # (including area code):
Extension (if any):
Mobile Phone # (including area code):
Direct Fax #:
Are you a Freelancer?	Select One: Yes No
We will be broadcasting text messaging updates during the Balloon Fiesta. If you have a messaging email address, please enter it here:
Badge Photo: Please attach a small (1MB or less) photo of your picture for your media badge. The photo must be either TIF or JPG.