PRESS – REGISTRATION FORM

PRESS REGISTRATION FORM World Allergy Congress 2009 December 6 - 10, 2009 Buenos Aires, Argentina Press Registration Form Media Registration Eligibility Requirements Media credentials will only be granted to journalists representing accredited media outlets for editorial coverage. You do not qualify for press credentials if you are: a publisher / a sales representative / any other non-editorial personnel. MEDIA REGISTRANT INFORMATION Company / Organization Media Outlet Name Mailing Address Zip Code City State Country Phone (Please specify country code + area code + number) Fax Number (Please specify country code + area code + number) Email Address Web Site ATTENDEE INFORMATION Last name Position Zip code Name Address City State Country Degree Phone (Please specify country code + area code + number) Fax Number (Please specify country code + area code + number) Mobile Email Address PRESS REGISTRATION FORM World Allergy Congress 2009 December 6 - 10, 2009 Buenos Aires, Argentina PRESS QUESTIONNAIRE (Please check all applicable) Newspaper: ___ Magazine: ___ Journal: ___ Radio: ___ Television: ___ Other: __________ REQUIRED MATERIAL FOR RECEIVING OFFICIAL APPROVAL  A letter verifying assignment to the meeting on the letterhead of the news organization being represented.  Media identification (such as an international accredited press pass), or a business card issued by a recognized news organization. Please complete one form per attendee, attach the letter of assignment and a copy of your media identification and fax them to: Débora Pamo - Media Contact XXI World Allergy Congress  0054 11 4314 3883 Should you have any doubts or questions, do not hesitate to contact the Media Management Office at dpamo@jmoribe.com or at 0054 11 4314 3883. By signing below, I acknowledge that I have read and agree to abide by all media guidelines governing the XXI World Allergy Congress. Signature: _________________________ ________ Date: _______________ Deadline to submit the completed form and required attachments is November 15th, 2009 Note: The XXI World Allergy Congress reserves the right to deny or revoke any credential or pres