For Ukrainian and Foreign Media Representatives

REGISTRATION FORM

for Ukrainian and foreign media representatives

Visit (press tour) to the Chernobyl Exclusion and Mandatory Resettlement Zone (18 April)

Kyiv Summit on Safe and Innovative Use of Nuclear Energy (19 April)

Chernobyl Pledging Conference in Partnership with G8 (19 April)

International Conference “Twenty-five Years after Chernobyl Accident. Safety for the Future” (20-22 April)

1.  / Media type
(underline) /
2.  / Family Name
3.  / Given Name
4.  / Passport No.[1] and issuing authority
5.  / Nationality
6.  / No. and validity term of the accreditation issued by the Ministry of Foreign Affairs of Ukraine (for foreign media representatives)
7.  / I would like to participate in the following events / □  Visit (press tour) to the Chernobyl Exclusion and Mandatory Resettlement Zone (18 April)
□  Kyiv Summit on Safe and Innovative Use of Nuclear Energy (19 April)
□  Chernobyl Pledging Conference in Partnership with G8 (19 April)
□  International Conference “Twenty-five Years after the Chernobyl Accident. Safety for the Future” (20-22 April)
8.  / Native/spoken language
9.  / E-mail
10.  / Telephone

Each participant must also send his/her 4x5 cm color photo in a JPEG file not exceeding 300 KB as an attachment to the completed Registration Form. The image definition must be 600 x 800. The file name must contain only Latin characters and have the following structure: Media name_Participant’s last name_Participant’s given name (Example: TV Ukraina_Petrenko_Pavlo)

[1] Foreign journalists who would like to visit the Chernobyl Exclusion and Mandatory Resettlement Zone and have two passports (domestic and travel) are kindly requested to indicated the no. of the passport which will be used for the trip.

The form must be completed electronically and sent to the Department of Information Policy of the Ministry of Foreign Affairs of Ukraine at: . Media representatives wishing to participate in the visit to the Chernobyl Exclusion and Mandatory Resettlement Zone must also send a copy of this message to the Press Service of the Ministry of Emergency Situations of Ukraine at: