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Media Registration

This is the registration form for euroasiaPRESS 2012. For Globalpress Summit2012 click HERE

Email: *
Password: *
Password (again): *
Salutation:
First Name (given name, as it appears on your passport): *
American Name (if applicable):
Last Name (family name): *
Publication Name: *
Publication Type:
Address Line 1: *
Address Line 2:
City: *
Postal Code: *
Country: *
Telephone (office): *
Telephone (mobile):
Web Page:
Publication Profile (short overview in 100+ words):
Circulation/Frequency:
Publishing House:

Airline Travel

Airport:
Departure Date:
Alternate Departure Date:
Return Date:
Alternate Return Date:
Do you have a valid Visa to enter the U.S.A.?:     
Passport Number:
Passport Expiration Date:
Birth Date:

Professional Profile

What is your favorite topic to write about?:
What other topics do you write about?:
How long have you been a journalist/editor for this industry?:
Do you write primarily on technology issues/product development or business/industry aspects?:

Accommodations

Room Preference:     
Other Requirements (Dietary...):
I would be interested to meet with the following companies:
This personal information is required to book your air tickets. Be assured that we keep this information strictly confidential.