Registration Form

Mr./Mrs./Miss 
Family Name 
First Name/s
Middle Name
Passport name (if different)
The following data concern the issuing of visa (if necessary)
Date and Place of Birth
Passport Number
Expiring
Nationality
Visa to be issued at Embassy/Consulate

Personal address
Street
City (include postal code)
Country
Phone
Cellular phone
Fax
Email

Professional address (if available)
Institution
Department / Redaction
Street
City (include postal code)
Country
Phone
Fax
Email

Contact address for all FIPRESCI matters
private address / professional address

In case you indicated your private address as contact address for FIPRESCI, but don't have a fax at home, please give the fax number which can be used to contact you

Professional Profile

Are you writing on film as 
staff member of a publication / freelance

In case you are working as freelance, are you employed by another institution (for example university)? Please specify 

If you are employed by another institution: How many percent, approximately, of your work is dedicated to film criticism or film journalism? 

Do you review films? How often?

Do you publish reports, interviews, portraits on cinema? How often?

Do you write about television? About films in television? How often?

Which festivals do you normally attend? How many space do you have for your reports?

Are you, temporarily or regularly, working, on a financial base, for other institutions or companies of cinema or television? Festivals? Production or distribution companies? PR agencies? Any other 

Publication 

(Staff members should indicate their media; freelancers should indicate the main media they are contributing to)

Name 
(Please quote the original name of the publication, not its English translation)
City
Kind Newspaper – Magazine – Radio – Television - Press Agency - Electronic publishing - Other. Please specify
Periodicity of the publication
Distribution local / regional / nationwide
Circulation (in case of print media printed circulation)
In case of publications not specialized on cinema
Does the publication have special pages on culture? On cinema?
How much space do you have for articles on cinema?
Please specify the kind of writing 
In case of television 
Do you mainly compose, as author or editor, emissions on film? Are you buying films (or advising the concerned department)?

Do you contribute regularly also to other publications? Please specify.

Which publication should appear together with your name, in all negotiations with festivals, in letterheads and publications of FIPRESCI?

Other information

Are you member of the journalist organization of your country?

Which languages do you speak fluently?

What are, in cinema, your special qualifications and interests?

Published books

Please add
- a pass-photo (for your FIPRESCI badge)
- some of your articles

In case your data would change, please inform FIPRESCI.

Sent by National Section
Date
The National Section supports this registration.
President, signature

Please return to 
Klaus Eder / FIPRESCI
Schleissheimer Str. 83, D-80797 Munich
T +49-89-18.23.03 F +49-89-18.47.66
Email keder@fipresci.muc.de

Digitized versions of this form are available (via email, on disk)