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Application Form

Fields marked with * are mandatory
1. Personal details
Surname*:
First name(s)*:
Gender*: Male Female
Nationality*:
Address*:
Country*:
E-mail address*:
Telephone number*
(including country code):
2. Media Organisation Details
Name of media organisation*:
Address*:
Type of medium*:

Other:
Employment status*:

Other:
Press card No*:
Name of supervisor*:
Supervisor's telephone number*:
Supervisor's email address*:
Working language(s)
of your media organisation*:
Your main topic(s)
of interest *:
3. Supporting documents
Press card*
(JPEG, PDF or TIFF Files ONLY
Max 2MB)
ID/Passport*
(JPEG, PDF or TIFF Files ONLY
Max 2MB)
4. Deadline for Application: 9 May 2011




Quotes

Jack Dangermond, USA
Champion of the Earth 2013 - Entrepreneurial Vision

We are moving into a world where everything that changes and moves is measured and made available by way of the web to everyone. And that's going to affect how people think and how they behave, how they act.


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