I am requesting the following media credentials (please check all that apply. Those fields with an asterisk *, are required):
Reporter	Photographer	Other
Newspaper	Magazine	Television	Radio	Online
Relationship to Media	StaffFreelance

* First Name:
* Last Name:
Title:
Organization/Affiliate:
* Web Address of Organization/Affiliate:
* Phone:
After Hours:
Fax Number:
* Email Address:
* Mailing Address:
* City:
* State:	Other Select a State ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FEDERATED STATES OF MICRONESIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA NORTHERN MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
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*Which race/races will you be covering(Please check all that apply

Day 1: Philadelphia, PA (Circuit Race) June 24

Day 2: Downingtown, PA (Stage Start) June 25

Carlisle, PA (Stage Finish) June 25

Day 3: Camp Hill (Stage Start) June 26

Bedford, PA (Stage Finish) June 26

Day 4: Bedford, PA (Stage Start) June 27

Latrobe, PA (Stage Finish) June 27

Day 5: Ligonier, PA (Stage Start) June 28

Pittsburgh, PA (Stage Finish) June 28

Day 6: Pittsburgh, PA (Circuit Race) June 29

So that we can help you obtain the coverage that you need, please list any other requests below (Specific interviews, access/footage needed, special story angle, phone lines, etc.):

Please list 3 of your most recently published articles/photographs/news footage:

* How would you like to be contacted (please check one): Email Fax

The Tour of Pennsylvania staff reserves the right to refuse or revoke media credentials. Thank you for your interest in the Tour of Pennsylvania. We look forward to working with you and your staff.