Summit to Commemorate the 10Th Anniversary of The

MEDIA ACCREDITATION

for

Summit to Commemorate the 10th Anniversary of the

PetroCaribe Agreement

September 5-6, 2015

Montego Bay Convention Centre, St. James, Jamaica

Please complete and return form with one (1) passport size photograph by Monday, August 24 to:

Ms. Judith Hunter

Jamaica Information Service

58a Half-Way Tree Road

Kingston 10

E-mail:

Tel. (876) 929-1919; Fax: (876) 754-4051

Please fax or e-mail form

FULL NAME:
DATE OF BIRTH:
ORGANISATION: / ______
BUSINESS ADDRESS:
PHONE/FAX
EMAIL:
PASSPORT NUMBER: / NATIONALITY:

POSITION:

REPORTER PHOTOGRAPHER
TECHNICIAN CAMERA PERSON
EDITOR OTHER

APPLICANT’S SIGNATURE: ………………………………………………………………………………

AUTHORISING OFFICER’S SIGNATURE: ………………………………………………………………..

OVERSEAS APPLICANTS KINDLY NOTE:

YOU ARE REQUIRED TO ATTACH A DETAILED LIST OF EQUIPMENT ALONG WITH THE FOLLOWING INFORMATION TO ASSIST WITH CUSTOMS CLEARANCE:

DATE OF ARRIVAL:

AIRLINE:

PORT OF DISEMBARKMENT: KINGSTON MONTEGO BAY

DATE OF DEPARTURE:

VOLTAGE: 50 cycle 110/120 voltage