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Media Accreditation Form
First name
*
Last name
*
Phone number
*
Email
*
Role
*
Please Select
Reporter
Television Broadcast
Radio Broadcast
Podcast
Photographer
Scout
Other
Media Affiliation (Company Name)
*
Supervisor Name
*
Supervisor Contact
*
Accreditation Type
*
Please Select
Full Season
Single Game(s)
Practice
Single game/Practice date requests
*
if requesting a practice credential, please provide the preferred date(s) you’d like to attend and any potential player/staff interview requests”
Would you like to be added to the Belleville Sens media distribution list?
*
Yes
No
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