MEDIA ACCREDITATION
APPLICATION FORM
| NAME : ORGANIZATION : POSITION : Reporter, Photographer, Technician Other (please specify) ……………………….. BUSINESS ADDRESS: ADDRESS DURING CONFERENCE: |
| PLACE /DATE OF BIRTH: PASSPORT NO: NATIONALITY: PRESS CARD NO : ISSUING AUTHORITY: |
| Enclose a letter of assignment from Editor/Executive of Organization and two current color photographs (3 x 4 cm) and return to the Media Secretariat no later than June 18, 2004. Foreign media: A journalist visa is required to cover the conference. Please contact the nearest Indonesian Embassy/Representative Office (www.deplu.go.id) For further information please contact the Directorate for Information & Media Services, Department of Foreign Affairs of the Republic of Indonesia through Mr. Henry Kaitjily at phone: 62-8129516070; 62-21-3813453 ext. 4519, 3440488; fax:62-21-3857316 or e-mail to fasmedia@deplu.go.id or Mr. Arsi Dwinugra Firdausy at phone: 62-8161131820; 62-21-3813453 ext. 4520 |
