©ITU MEDIA ACCREDITATION FORM
ITU Plenipotentiary Conference
Sungate Port Royal Hotel
Antalya, Turkey
6–24 November 2006
Please read carefully the Media Accreditation Procedure before completing this form!

* = Required Field

CONTACT INFORMATION
Mr   Ms
* First Name:
* Family Name:
*Job Title:
  Country Area Number Extension
Telephone:
Mobile:
Fax:
* e-Mail:
Website:
DATA PRIVACY

ITU may publish the information provided on this form on the ITU website. Please tick this box if you do not want your details to be made available  

By default, accredited media are placed on the ITU media information mailing list. Please tick this box if you do not want to continue receiving ITU media information after the Event.  

PUBLICATION / MEDIA DETAILS
* Name of Publication / Radio / TV station / News Wire Service:
 
* Country of Parent Company:  
FAST TRACK ACCREDITATION DETAILS
I am accredited at:  ITU TELECOM WORLD 2006  the United Nations in New York  Geneva  Nairobi  Vienna
ITU PLENIPOTENTIARY CONFERENCE ATTENDANCE DATES
Date of arrival   Date of departure
DOCUMENTATION
I wish to receive the documentation in: English  French  Spanish 
 
FULL ADDRESS OF PUBLICATION / RADIO / TV STATION / NEWS WIRE SERVICE1
* Address:

PO Box:
* Postal Code:
* City:
State / Territory:
* Country:
ADDRESS WHERE DOCUMENTATION SHOULD BE SENT, IF DIFFERENT FROM THE ADDRESS OF MEDIA GIVEN ABOVE
Address:

PO Box:
Postal Code:
City:
State / Territory:
Country:
 
* MEDIA CATEGORY
Daily press
General Correspondent
Technology Correspondent
Business Correspondent
Trade Press
Economic/Business Press
On-Line Publication
News Wire service
Industry Analyst
(Newsletters staff only)
Audiovisual press
TV Station
Radio Station
Press Photographer
 
DIRECT LINK TO BYLINED ARTICLES / EDITORIAL STAFF LISTING:
 
ACCOMPANYING TEAM MEMBERS (CAMERA CREW, TECHNICIAN, PHOTOGRAPHER, ETC.) SHOULD BE LISTED HERE:
Prefix: Mr   Ms
First Name:   Last Name: 
Job Title:
Organization:
A minimum of 1 of the following 2 fields is required:
e-Mail:
  Country Area Number   
Mobile:
 
Prefix: Mr   Ms
First Name:   Last Name: 
Job Title:
Organization:
A minimum of 1 of the following 2 fields is required:
e-Mail:
  Country Area Number   
Mobile:
 
Prefix: Mr   Ms
First Name:   Last Name: 
Job Title:
Organization:
A minimum of 1 of the following 2 fields is required:
e-Mail:
  Country Area Number   
Mobile:
 
Prefix: Mr   Ms
First Name:   Last Name: 
Job Title:
Organization:
A minimum of 1 of the following 2 fields is required:
e-Mail:
  Country Area Number    
Mobile:
 
 
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