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					                    Media Template
       International Polar Year 2012 Conference
             “From Knowledge to Action”
Please complete the form below to have information about your presentation at
IPY2012 included as part of the Media Guide to be distributed to all accredited
media.

Information on the participants / stakeholders / presenters of the
conference interested in speaking to the media

Name of stakeholder, title and affiliation :



Short biography and area(s) of expertise:




E-mail address:



Cell. phone number:



How do you wish to be contacted during the conference?
( ) By cell.
( ) By e-mail

Are you presenting during the conference? If so, when:



Quote to be used by media (50 words or less):



                                       -2-
Languages spoken:




Availability
Dates of stay in Canada (or at the conference for Canadian residents):




For additional information:

Jacques Lavigne
Media relations – IPY 2012
Tel : 514-283-1104
Cell : 514-949-1650
e-mail : IPYmediaAPI@bell.net

				
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posted:8/7/2012
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