Media accreditation form
Anjou Vélo Vintage

First name

Name

Media

TV

Radio

Press

Website

Blog

Photograph agency

Press agency

Freelance

Alternative media type

Media name

Position

Journalist

Cameraman

Photograph

Engineer

Alternative position

Address

Post code

City

Fixed line number

Cellphone number

E-mail address

Press card number

Do you want to take part in a retro ride?

Yes

No

Do you need a vintage bike?

Yes

No

Do you want to be part of it?

Do you require a trade stand?

Information Request

Une organisation :