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ProfessionalApplication2020-Fillable

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PENNSYLVANIA PRESS PASS & SUPPLIES
Media personnel who work or freelance for a PNA member news media
company are eligible to apply for a Pennsylvania Press Pass, a personalized
press credential. Offered by the PNA, a Pennsylvania Press Pass is issued
annually and helps media personnel gain access to accident and incident scenes.
A Pennsylvania Press Pass is not a government ID, but has been widely
publicized to law enforcement agencies as a way to help police and other
emergency personnel quickly identify and verify media personnel.
Pennsylvania Press Passes expire on December 31 of each year and applications must be
submitted annually. Applications for Pennsylvania Press Passes are approved at the sole
discretion of the PNA.
Please note: Pennsylvania Press Passes are for identication purposes only and may be
revoked at any time by the PNA.
Applications must be completed and signed by the
Sponsoring Contact. A Sponsoring Contact is the sponsoring
publisher, editor or general manager. The Sponsoring Contact
must include a job title, phone number and email address for
each applicant. All Pennsylvania Press Passes will be sent to the
Sponsoring Contact, not to the individual applicants. The
Sponsoring Contacts are responsible for the accuracy of
information on all applications submitted and must return the
Pennsylvania Press Pass of any holder leaving his or her
employment or any freelancer whose contract has terminated.
Completed passes will be mailed to the attention of the
Sponsoring Contact, and passes will list the phone number of
the Sponsoring Contact for law enforcement verication
purposes.
PHOTO REQUIREMENTS
A photo is required for each Pennsylvania
Press Pass. Photos must be a JPG le, sized
as follows:
7/8’’ (.875) x 1’’, 300 dpi.
Name each attached le as
lastnamerstname.jpg. Please email the
le(s) to communications@pa-news.org,
noting Pennsylvania Press Pass in the subject line. PNA reserves
the right to refuse to produce a Press Pass if the appropriate
photo is not submitted.
1”
7/8”
Directions to apply
TO APPLY
Return the completed and signed application(s),
along with payment for an amount equal to $10, plus tax,
for each applicant, to:
Attn: Membership Manager
Pennsylvania NewsMedia Association
3899 North Front Street
Harrisburg, PA 17110
Please allow up to three weeks for application to be processed.
QUESTIONS? PLEASE CONTACT:
Membership Manager
(717) 703-3069
communications@pa-news.org
Approved applicants can be veried by law enforcement personnel by visiting www.panewsmedia.org
and selecting Pennsylvania Press Passes under Services.
Hang Tags
Hang tags are available to PNA
members and are a great press
identier.
Security Vests
PNA members can also purchase security vests
to keep reporters visible while covering breaking
news and other events.
PENNSYLVANIA PRESS PASS APPLICATION
Applicants for 2020 Pennsylvania Press Passes
(attach a list for additional names)
Name: ________________________________________________
Title: _________________________________________________
Email: ________________________________________________
Phone: ________________________________________________
Name: ________________________________________________
Title: _________________________________________________
Email: ________________________________________________
Phone: ________________________________________________
Name: ________________________________________________
Title: _________________________________________________
Email: ________________________________________________
Phone: ________________________________________________
Name: ________________________________________________
Title: _________________________________________________
Email: ________________________________________________
Phone: ________________________________________________
Name: ________________________________________________
Title: _________________________________________________
Email: ________________________________________________
Phone: ________________________________________________
Name: ________________________________________________
Title: _________________________________________________
Email: ________________________________________________
Phone: ________________________________________________
I certify that these applicants are eligible for a Pennsylvania Press Pass under the qualifying rules:
____________________________________________________________________________________
Signature of sponsoring publisher, editor or general manager Date
Sponsoring Contact Information:
Name: _______________________________________________________________ Title: _______________________________________________
News Media Company: _____________________________________________________________________________________________________
Address: ___________________________________________________________________________________________________________________
City: _____________________________________________ State: __________ Zip: ________________
Phone: __________________________________________________ Email: _________________________________________________________
CHECK IS ENCLOSED.
Make checks payable to MANSI (Mid-Atlantic Newspaper Services Inc.).
Payment
CHARGE MY CREDIT CARD
(VISA, Mastercard, Amex)
Card Number: ___________________________________________
Expiration Date:
__________ Security Code: ______
Exact Name on Card: ____________________________________
Billing Address: Same as above
Address:
____________________________________________
City: ______________________ State: _______ Zip: ______
Order
________ Press Passes x $10 each: $ _________
________ Hang Tags x $7 each: $ _________
________ Security Vests x $15 each: $ _________
x PA sales tax (.06) $ _________
TOTAL AMOUNT $ _________
Mail completed form to Membership Manager, Pennsylvania
NewsMedia Association, 3899 North Front Street, Harrisburg,
PA 17110 or fax to attn: Communications at (717) 703-3001.
Please also email applicants’ photos to communications@pa-
news.org noting PA Press Pass in the subject line. The photo
must be a JPG le: size 7/8” (.875) x 1”, 300 dpi and the le
saved as lastnamerstname.jpg. Applicants cannot be processed
without completed and signed applications and submitted photos.
Please allow up to three weeks for application to be processed.
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Completed 3 July 2020

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