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Media Credential Request Form


Note: All fields are required unless otherwise noted.

Contact Information
First Name: Affiliation:
Last Name: Title:
E-mail Address: Phone Number:
Mailing Address: City:
State: ZIP Code:

Credential Information
Day(s) of Attendance:
Thursday, May 26, 2011
Friday, May 27, 2011
Saturday, May 28, 2011
Credential 1
First Name: E-mail Address:
Last Name: Cellphone Number:
Type of Credential:
Credential 2 (optional)
First Name: E-mail Address:
Last Name: Cellphone Number:
Type of Credential:
Credential 3 (optional)
First Name: E-mail Address:
Last Name: Cellphone Number:
Type of Credential:
Credential 4 (optional)
First Name: E-mail Address:
Last Name: Cellphone Number:
Type of Credential:

More Information
For more information, please contact Mark Beckenbach, Ohio Wesleyan University Sports Information Director by calling (740) 368-3340 or e-mailing mlbekcen@owu.edu.