AFRICAN UNION

UNION AFRICAINE
UNIO AFRICANA

2nd High Level Dialogue on Governance and Democracy

Trends in Africa
MEDIA REGISTRATION/ACCREDITATION FORM
- Please note that only accredited journalists will be allowed at the venue -

1. REGISTRATION (for all media)

Kindly register to cover the event remotely (access to PR Team, Emailed Press Releases, Interviews)

Email this form to: Chem-LangheeP@africa-union.org, paschalchem@hotmail.fr

TYPE OF MEDIA (select): PRINT ____ RADIO ____ TV____ ONLINE____ BLOG ____ OTHER ___
LANGUAGE: EN____ FR____ PT____ AR____
REPORTER/CONTACT PERSON: ____________________________
MEDIA COMPANY: ______________________________________
CITY/COUNTRY: ________________________________________
COMPANY WEBSITE: ____________________________________
EMAIL: _______________________________________________
PHONE No.: ___________________________________________
SPECIAL INTEREST IN (themes): ____________________________________________________

Is your company sending a team to Dakar? If yes, please fill in Section 2.

2. ACCREDITATION (additional, for media on site only)

Kindly request Accreditation and security badge(s) in order to cover the event on site in Dakar.

Email this form to: Chem-LangheeP@africa-union.org, paschalchem@hotmail.fr

NUMBER OF SECURITY BADGES REQUESTED (max. 4): _____
TEAM LEADER/CONTACT PERSON: _________________________
I.D./PASSPORT No. (for security badge): ____________________
OTHER CREW MEMBERS (photographers, cameramen, sound, producers, etc)
NAME: __________________________ ROLE: ______________ I.D./Pass. No. _____________
NAME: __________________________ ROLE: ______________ I.D./Pass. No. _____________
NAME: __________________________ ROLE: ______________ I.D./Pass. No. _____________
EQUIPMENT BROUGHT IN: ______________________________________________________
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