1. Your Full Name:

• Last: Miles
  First: Cecil
  Middle: -

2. Birthdate:

• 20/NOV/1991

3. Birthplace:

• Los Santos

4. Sex:

• [X] Male
  [—] Female

5. Race/Ethnic Category:

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

6. Address:

• 3005-B San Andreas Ave Downtown

7. Contact Number:

• 9791821

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8. Employer: San Andreas Network

• If you are self-employed, PLEASE indicate.
  Position/Job Title: CEO
  Business Address: 3005-B San Andreas Ave Downtown
  Work/Mobile No: 9791821
  
  Provide a brief description of your job duties as it applies to the need for an LSPD media card: Full-time news agent

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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: Cecil Miles

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10. Timezone (GMT):

• GMT +1

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

• ACCESS
  
  
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