VIP MEDIA ACCESS FORM
Please complete the form below and click "Submit." A VISIT FLORIDA PR representative will review your request. Should you have questions about any section of this form, contact the VISIT FLORIDA Public Relations Department at 850-488-5607. Requests must be made at least three weeks prior to travel. * indicates a required field
*Are you seeking:
Florida Facts
Corporate Information
General trip or story assistance
Other. Please describe:
*Are you a media outlet from:
United States
Canada - English
Canada - Français
Deutschland
Español
Português
United Kingdom
Other.
Please describe:
PERSONAL INFORMATION
*Name as Appears on Photo I.D.:
Nickname:
Job Title:
*E-mail Address:
*Street Address:
*City:
*State/Province:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Virgin Islands
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
*Zip or Postal Code:
*Country:
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguila
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic
Cook Islands
Costa Rica
Cote D'Ivoire (Ivory Coast)
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Czechoslovakia (former)
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
F.Y.R.O.M. (Macedonia)
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain (UK)
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Neutral Zone
New Caledonia
New Zealand (Aotearoa)
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
S. Georgia and S. Sandwich Isls.
Saint Kitts and Nevis
Saint Lucia
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard & Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
US Minor Outlying Islands
USSR (former)
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire (CD Congo, Democratic Republic)
Zambia
Zimbabwe
*Work Telephone Number:
Home Telephone Number:
Mobile Telephone Number:
Fax Number:
Emergency Contact Name and Telephone Number:
Food Allergies or Other Medical Conditions:
Date of Last Visit to Florida and Cities Visited:
MEDIA INFORMATION
*Publication/Station Name (If you're a freelance writer, please indicate where the story will appear):
Circulation/Audience Size:
Audience:
Distribution Area:
Frequency of Publication/Broadcast:
Languages:
*Story Angle Focus:
Expected Run Date:
*Will you be on assignment for your trip to Florida:
Yes
No
If yes, please provide editor's name and contact information:
If no, please provide proof of relationship with publication/station and reason for trip (i.e. recent travel clips, letter from editor, etc.):
TRAVEL INFORMATION If you are requesting trip assistance, please complete the following.
Proposed Arrival Date and City:
Proposed Departure Date and City:
Mode of transportation:
If there are additional media representatives traveling in your group, please list full names and job titles:
Specific areas in Florida you plan to visit (Include dates for each area):
Activities Request (Specify how many tickets/passes):
Will these activities be mentioned in the story?
Yes
No
Are accommodations needed?
Yes
No
If yes, will you mention the host hotel(s) in your story?
Yes
No
If complimentary arrangements are not available, will you accept media rates?
Yes
No
If yes, what is your price range in $ U.S.?
Room Type (i.e. Single/Double):
Smoking:
Yes
No
If you are a journalist and would like to upload samples of your work (PDF or .doc format) for our review, please use the fields provided below:
File #1
File #2
File #3
File #4
To request entry to VISIT FLORIDA's VIP Media or Film Access , a list of special offers specifically for media or film representatives working on assignment in Florida, please select one of the following.
VIP Media Access (For traditional travel feature writers and broadcast travel media working on assignment in Florida.)
VIP Film Access (For production companies working on films, episodes and commercials that feature Florida destinations).
If you select entry to the VIP Media or Film Access program, then your contact information will be shared with the organizations offering media or film specials. Please select one of the following.
Share only address and phone number
Share only e-mail address
Share all contact information