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Credential Application Form 
Georgia House of Representatives > Media Services > Credential Application Form
Credential Application Form

Employer:  (Required)
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Name:
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Job Title:  (Required)
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Are you a first time applicant? (Yes or No):  (Required)
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Type of Credentials Requested?:
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If requesting a one-day pass, what date would you like to request a one-day pass?:  
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If your news organization is a newspaper or news service, how often is it published or produced?
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     *Specify: 00:00:00/00:00:00
Publication City & State:
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Contact Phone Number:
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Email Address:  (Required)
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Work Address:
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(City, State, Zip):
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Website:  (Required)
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How long have you been employed by your news organization?:
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Do you or does your news organization (currently, or in the past) directly or indirectly engage in coordinating news coverage with a political organization or candidate? If so, please describe. (Required)
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Are you currently, or have you previously worked as a paid lobbyist, paid staff worker or a consultant for a political candidate or political organization? If so, please describe. (Required)
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Comments:
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Do you agree to the Terms of Service (Yes/No):
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Terms of Service: “By submitting 'Yes,' you confirm that you have read and agree to the Georgia House of Representatives House Media Rules, Media Decorum and confirm that information above is accurate. By submitting 'Yes,' you also confirm that you are not a lobbyist or staff worker for a political candidate or organization.”