Farm Aid-issued credentials are required for all media attending Farm Aid 2016 and will only be distributed to professional media and photographers. Credentials may only be picked up on-site the morning of the concert with photo ID. Media credentials allow access to the news conference and the designated media area at Jiffy Lube Live. Please review Farm Aid’s 2016 Media Policies prior to filling out the credential request form below. All credentialed media are expected to be compliant with the official Farm Aid 2016 policies. If you choose to purchase or have already purchased a ticket for the concert, your $30 credentialing fee will be waived. After you fill out the form below, please email a proof of purchase of your ticket to Faith James directly at firstname.lastname@example.org to complete your credential request. If you arrive at the venue on the day of the concert and are not affiliated with a professional media outlet or approved documentary crew and/or do not have professional equipment, credentials will not be issued, and a refund will not be credited. Friends and family of credentialed media are not eligible for media credentials. Tickets may be purchased through the LiveNation website, the venue box office, or by phone at 800-745-3000. Credentialed media may enter and exit the designated media area at Farm Aid 2016 as often as needed to meet with friends and family at the show, however, all media policies will be in effect. Questions Please contact Faith James at 202-248-5450 or by email at email@example.com. Confirmation of receipt will be provided automatically to the email you provide below, if you do not receive a confirmation email, please contact Faith James at the email above. Please complete one form per person that you are requesting a credential for. All credential requests for Farm Aid 2016 must be received by Friday, September 8, 2016. Have you already purchased a ticket to Farm Aid 2016?*YesNoIf yes, please send your proof of purchase to firstname.lastname@example.org.Name* First Middle Last Job Title*Organization*Email* Business Phone*Cell Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Interview Requests / NeedsChoose your credential type*Choose one:PhotographerBroadcastReporterDocumentary FilmmakerRegistration Fee* Price: $30.00 Farm Aid use only Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20162017201820192020202120222023202420252026202720282029203020312032203320342035 Expiration Date Security Code Cardholder Name Please noteOnly one Farm Aid photo credential will be issued per media outlet. If you arrive at the venue on the day of the concert and are not affiliated with a professional media outlet and/or do not have professional equipment when you arrive, credentials will not be issued and a refund will not be credited. Farm Aid 2016 will be held September 17 at Jiffy Lube Live, rain or shine.