![](media/image1.pct){width="7.408333333333333in"
height="2.138888888888889in"}

+--------------------------+-------------------+-----------------------+
| ## **MEDIA INFORMATION** |                   |                       |
+--------------------------+-------------------+-----------------------+
| Media                    |                   |                       |
| Organization/Company     |                   |                       |
+--------------------------+-------------------+-----------------------+
| Media Representative     |                   |                       |
+--------------------------+-------------------+-----------------------+
| Address                  |                   |                       |
+--------------------------+-------------------+-----------------------+
| Phone                    | Fax               | Email                 |
+--------------------------+-------------------+-----------------------+

**Date Form Completed** Advance On-Site
[\_\_\_\_/\_\_\_\_\_/\_\_\_\_\_]{.underline}

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| ### ACCREDITATION CATEGORY                                            |
+-----------------------------------------------------------------------+
| ( ) WP: Written Press ( ) PJ: Photo Journalist ( ) BTV: Broadcast TV  |
| ( ) CTV: Cable TV ( ) R: Radio                                        |
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**NOTE:** You must attach a copy of the **photo ID/credential** issued
to you by your media company with this application.

+-----------------------------------------------------------------------+
| #### **MEDIA COVERAGE**                                               |
+-----------------------------------------------------------------------+
| Please indicate below the events you are interested in covering (see  |
| attached Schedule of Events)                                          |
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|                                                                       |
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|                                                                       |
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**Media guests must wear an official Games Media Credential tag during
the event.**

A Games credential name tag will be mailed in advance to media
representatives who have completed this form prior to the Games.

All media representatives who have not completed the form must report
directly to the **Wheelchair Games Media Center**, located in room 102C
of the Midwest Center, in order to pick up a credential name tag prior
to covering an event.

**For advance credentialing, please complete the media form and e-mail,
fax or mail to:**

**John W. Zewiske**

**Joseph O. Streff**

Media Support Coordinators

27^th^ National Veterans Wheelchair Games

Department of Veterans Affairs Medical Center

5000 West National Avenue

Milwaukee, WI 53295

Phone: (414) 382-5363 Cell: (414) 234-7356 Fax: (414) 382-5370

E-mail: john.zewiske@va.gov; or joseph.streff@va.gov