MEDIA FORM

FIRST NAME (NAMES)*

LAST NAME*

DATE OF BIRTH*

COUNTRY*

TELEPHONE*

E-MAIL*

NAME OF FOREIGN MEDIA ORGANISATION*

HEADQUARTERS ADDRESS*

TELEPHONE*

E-MAIL*

TYPE OF MEDIA ORGANISATION*

Please mark the appropriate option(s)

TVRadioNewspaperJournalNews agencyBroadcasterFilm, audio, visual studioOther

YOUR POSITION*

Please mark the appropriate option(s)

EditorPhotographerJournalistCameramanOther

A copy of valid national press card issued by a national journalist union and/or the represented foreign media organisation with the date, the seal of the organization or/and the signature of the head of the organization
*

Documentary photo (JPG format)*

I hereby consent to the collection, storage and processing of my personal data for the purpose of the accreditation pursuant to the Personal Data Protection and Processing Rules of the Archdiocese of Vilnius and the Law of the Republic of Lithuania on Legal Protection of Personal Data.*

I hereby declare that the information provided by me is true, complete and accurate.*