<p> 2015 US Youth Soccer Region I (East) Championships Barboursville Soccer Complex and Scott Orthopedic Soccer Complex June 25 – June 30, 2015 APPLICATION FOR MEDIA CREDENTIALS</p><p>NAME: ______POSITION: ______</p><p>AFFILIATION: ______PHONE: ______</p><p>EMAIL: ______TWITTER: @______</p><p>ADDRESS:______</p><p>AUTHORIZED SIGNATURE (EDITOR, NEWS DIRECTOR OR OTHER SUPERVISOR):______</p><p>NUMBER OF SPACES (SEATS) REQUESTED IN WORKING PRESS AREA:______</p><p>EQUIPMENT NEEDS: If you plan to work from the Media Center, please complete the portion of the form within the box below. Please check appropriate categories:</p><p>Please check type of outlet:  Print Media  Photographer  Radio/TV  Internet How often is your publication printed/show aired? Will you be filing daily?______Please note any special requests you may have:______</p><p>OTHER STAFF (writers, photo assistants, etc.) LIST NAME AND ASSIGNMENT:</p><p>______</p><p>______</p><p>NOTES We must receive completed application forms no later Media than Friday, June 18, 2015. Media credentials must be visible at all times. Freelance Credentials can be picked up at site. No credentials Photographers and writers must include proof of will be mailed in advance. If other staff requires assignment on letterhead with application. credentials, please copy this form, fill it out, and Social Media return it. Please use #ROADtoOK if posting content to Twitter, Facebook or Instagram. Credentials are NON-TRANSFERABLE. This policy is Twitter: @USYSNCS ; Instagram: @USYouthSoccer strictly enforced.</p><p>Please return no later than Tuesday, June 18 to:</p><p>Steve Prince, Communications Coordinator US Youth Soccer, 9220 World Cup Way, Frisco, Texas 75034 Tel: (800) 4SOCCER Fax: (972) 334-9960 Email: [email protected] </p><p>No. Requested No. Approved Notified Mailed Added to media list For internal use only:</p><p>No. Requested No. Approved Notified Mailed Added to media list</p>