media accreditation registration form by RGoBJpe


									                                                                                       Press Registration Form

                            The 19th World Congress of Consumers International
                       To register complete this form: (click    to type; or double click   to check ‘x’)
                     This form must be accompanied by the required documents requested on the website,
                           and returned to Kate Scott: or by FAX: +44 2073540607

Section A: Personal Details

Title:    Dr         Prof    Mr    Mrs       Ms

 Last Name:                                                                       First Name:


 Position / Title:

 Name, title & organisation for
 Congress badge & publication:

 Contact Email:

Section B: Which day(s) do you plan to attend Congress?

                                         Tuesday 3 May                 Wednesday 4 May          Both

 Section C:

Please indicate the capacity in which you will attend:

Journalist            Freelance Journalist        Journalism Student    Blogger

Note: You must provide proof of credentials to receive a complimentary press badge to attend the Congress. CI reserves
the right to grant press privileges to individuals on a case-by-case basis. Please refer to the Press Credentials and
Guidelines document for details of the credentials required.

    Signature _________________________________________                   Date _______________________________________


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