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Indstillinger til FIFA's Jules Rimet Award

Mandag d. 13. september 2004

Application form for the FIFA Jules Rimet Award
(Written Press/Photographers/Radio & TV Journalists)

IMPORTANT: Applicants must have worked at a minimum of 11 FIFA World Cups

Personal information (in CAPITAL letters only)
Surname: First Name:
Nationality: Country:
Telephone: Telefax:
E-mail:

Please list your details of FIFA World CupsÔ attended and tick appropriate box or boxes:

1. Function (tick the appropriate box or boxes)
Written Press Photographer Radio & TV Journalists

2. Category of media organisation you worked for during the 11 or more FIFA World CupsÔ (tick the appropriate box or boxes)
Agency Newspaper Magazine Website
TV Radio Freelance Other

3. Name(s) of the media organisation(s) you worked for during the FIFA World CupsÔ (IMPORTANT: each candidate is required to submit photocopies of his/her official accreditation from each of the FIFA World CupsÔ listed below):
FIFA World CupÔ Name of media organisation
1930
1934
1938
1950
1954
1958
1962
1966
1970
1974
1978
1982
1986
1990
1994
1998
2002

Signature of applicant Date

Applications and accreditation copies must be sent to:
FIFA Media Department - PO Box 85 - CH-8030 Zurich
Tel: +41 43 222 72 72 - Fax: +41 43 222 73 73
media@fifa.org

DEADLINE FOR SUBMISSION OF APPLICATIONS: 15 October 2004