FIPRESCI — Request of Participation
To a Jury or Conference 
Send to jury@fipresci.org

Jury at the festival
(Or conference)

Name
Family Name
First Name
Middle Name

Address 
(to which an invitation should be sent)
Street:	
City (include postal code)
Country
Phone number*
Cell Phone*	
Fax*	
Email 

(*)  Please use international format 
+country code (area code) number, 
for example +49 (89) 18 23 03

Publication 
in which the event will be covered
Main Publication
Specify if daily, weekly, monthly, radio, tv

Other publication/s (if) (incl. periodicity)	
Other publication/s (if) (incl. periodicity

If you did not participate in a FIPRESCI jury before, or not within the last three years, be so kind to supply evidence that you contributed, as film journalist or critic, at least three times to a regular publication over a period of the last 12 month.

Please note that national sections have the statuary right to propose candidates. This request can therefore only be considered if it is (informally) confirmed by your national section.

Date	

Please send this application in the body of an email or as an email with an attached file to:
jury@fipresci.org

FIPRESCI - International Federation of Film Critics
Schleissheimer Str. 83, D 80797 Munich, Germany
T +49 (89) 18 23 03 F +49 (89) 18 47 66
info@fipresci.org,  www.fipresci.org