Print, Electronic Media, Radio and Photographer

Media Accreditation Application

Please affix
passport size
photo here

Accreditation is being sought for (please tick the relevant boxes):

Qualifying Round

Vientiane, Laos

And / Or

Final Rounds (First Point of Collection)

Hanoi, Vietnam

Jakarta, Indonesia

Deadline for Qualifying Round application is Wednesday, 13 October

2010 and the Final Rounds application is Monday, 15 November, 2010
 1. GENERAL INFORMATION:
(For both accreditation categories – Journalist and Photographer)

Name:

Organisation:

Position:

Address:

City:

State: Postcode:

Country

Phone: Fax:

Mobile: Email:

Signature:

2. AGENCY CONTACT (for both accreditation categories)

All media seeking accreditation, including freelance journalists, must complete this section by providing the
contact name and phone number for their Commissioning Editor, Chief-of-Staff or Agency Director.

Name:

Position:

Organisation:

Phone:

Signature:

Deadline for Qualifying Round application is Wednesday, 13 October

2010 and the Final Rounds application is Monday, 15 November, 2010
3. APPROVAL FROM NATIONAL FOOTBALL ASSOCIATION

All media seeking accreditation must obtain the signature of their respective National Football Association.
The forms must be signed by the General Secretary or a senior official from the National FA. Accreditation
forms without the approval of the National Football Association will not be processed.

Approved by:

General Secretary National Football Association

Date:

Completed and signed forms are to be mailed or e-mailed to either:

Hanoi, Vietnam
c/o Vietnam Football Federation (VFF)
National Youth Football Centre
Le Quang Dao Str,
My Dinh, Ty Liem
HANOI
Vietnam

vff@hn.vnn.vn or vietnamff@gmail.com

Jakarta, Indonesia
c/o Persatuan Sepakbola Seluruh Indonesia (PSSI)
Gelora Bung Karno
Pintu X-XI, Senayan
P.O. Box 2305
JAKARTA 10023
Indonesia

pssi@pssi-football.com

AFF House
33, Jalan SS 3/76
Kelana Jaya
47300 Petaling Jaya
Selangor Darul Ehsan
Malaysia

admin@aseanfootball.org
Approved/ Rejected/ Pending
Deadline for Qualifying Round application is Wednesday, 13 October
2010 and the Final Rounds application is Monday, 15 November, 2010