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Portal information

E-mail *
Portal password The portal password has to be 8-20 characters in length and must contain upper case characters, lower case characters and numbers (and no other characters) *
Confirm
portal password
*
 
Personal information

Prefix *
First name *
Family name *
Date of birth *
Nationality *
City of birth *
Country of birth *
Photo Required format: JPG file, 100x100 px and no more than 100 kb size
 
Address (please provide your personal address, NOT your office address)

Street * / House no. *
City *
Postal code *
Country of Residence *
Phone number Please use the following format: +32-2-123456-123 *
Fax number Please use the following format: +32-2-123456-123
Mobile number Please use the following format: +32-2-123456-123
Twitter
 
Official information

Identification *
Identity number *
Issued by *
National press
card number
*
Issued by *
 
Media information

Type of media *
please define:
Organization *
Nationality of
media org.
*
Qualification *
 
I agree to the above mentioned data being stored and used in connection with my accreditation.
 

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