1. Your Full Name:

• Last: Montblanc
  First: Laura
  Middle: -

2. Birthdate:

• 21/JAN/1999

3. Birthplace:

• 19e, Paris, France

4. Sex:

• [—] Male
  [X] Female

5. Race/Ethnic Category:

• [—] Black
  [—] Hispanic
  [—] Asian
  [X] Caucasian
  [—] Pacific Islander
  [—] American Indian or Alaskan Native
  [—] Filipino
  [—] Two or more races

6. Address:

• 1222 Market Street, Market, Los Santos, San Andreas

7. Contact Number:

• 888-7777

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8. Employer: San Andreas Network

• If you are self-employed, PLEASE indicate.
  Position/Job Title: Journalist
  Business Address: Star Tower, Commerce, Los Santos, San Andreas
  Work/Mobile No: 888-7777
  
  Provide a brief description of your job duties as it applies to the need for an LSPD media card: My duties that will require an LSPD Media Card consists in:
  Exclusive Access:
  With the use of my LSPD Media Card, I hope to gain access into exclusive special operations and high risk situations, so I can provide the most accurate and objective coverage of news related to the Los Santos Police Department.
  Interviews, Press conference access:
  I also hope to have access to exclusive interviews with the LSPD media relation division, the San Andreas Network has the tools to get into a bigger audience, and with that allow the LSPD to send an important message if they have one in a very objective and unbiased matter, I would also like to gain access into the Conference room during press releases or speeches, and have the right to ask questions if it's a Q&A session.
  

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9. I certify that I have carefully read the information submitted on this application, and that it is true and complete. I understand any false information or withholding of information is grounds for the denial or revocation of my LSPD News Media Identification Card.

Signature in Full: Laura Montblanc

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10. Timezone (GMT):

• +1 GMT

11. Provide a link to your LS-RP community forum account:

• ACCESS

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