Media Accreditation Form


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MEDIA ACCREDITATION FORM

Mrs

Last name:

First name:

Job Title:

Contact person:
(if applicable)

Media category

Name of publication / Press Agency / TV / Radio Station:
Full address of publication / Press Agency / TV / Radio Station:
Address where documentation should be sent if different from above:
Tel:
Fax:
Mobile:
Email

URL:

Attending ITU TELECOM AFRICA 2001 on

	11/11 (VIP Day)		12/11		13/11
	14/11		15/11		16/11

Accompanying team members (camera crew, technician, photographer,etc) should be listed here:

Full Name(s):
Job title/function(s):

Alternatively, please print this form and fax your completed application to Ms Victoria Knight on +41 22 730 6444