ALL fields are required including photo.
Employee's First & Last Name:
Email:
Newspaper:
Newspaper's Mailing Address:
City:
, KY
Zip:
Newspaper's Phone Number
- -
Editor/Publisher Name:
"Editor/Publisher Signature"
I authorize the above employee to be issued a KPA Media Pass in the name of my newspaper. I also confirm that the applicant is a paid employee of this newspaper and does reporting/photography for the newspaper. I also agree to return the KPA Media Pass when employee leaves.

Photo REQUIREMENTS
* Full Color
* Minimum of 200 dpi & be 2 inches tall by 1.5 inches wide.
* File size can not exceed 2 MB.
* Mugshot/Headshot style photo

Photo:
No images over 2mb

Please only click the button once.
Confirmation will be displayed when file has been uploaded.

If you have technical problems contact Corey Wall - cwall@kypress.com