DIPLOMATC CONFERENCE.docVIP

DIPLOMATIC CONFERENCE FOR THE ADOPTION OF A REVISED TRADEMARK LAW TREATY SINGAPORE March 13-31, 2006 MEDIA ACCREDITATION FORM (Please see details of Media Accreditation Procedure below) PERSONAL DETAILS (all field must be completed): Prefix (Mr., Mrs., Miss,. etc.) First Name: Family Name: Title/Function: Passport Number: Nationality: Date of Birth: CONTACT DETAILS (all fields must be completed): Organization/Company: Street: City: State/Province: Country: Zip/Postal code: Telephone Number: Mobile Number: Facsimile: E-Mail Address: FAST TRACK ACCREDITATION DETAILS: □ I am accredited at the United Nations in New York □ Geneva □ Vienna □ □ I am an accredited journalist in Singapore MEDIA CATEGORY: □ General Correspondent □ Intellectual Property (Trademark) Correspondent □ Business Correspondent □ Trade Press □ Economic/Business Press □ Press Agency A/V PRESS: □ TV Station □ Radio Station □ On-line publication □ Press Photographer Equipment Requirements – for purposes of customs clearance and to ensure on-site facilities, please specify any equipment you will be taking to Singapore: Note: By default accredited media are placed on the WIPO media information mailing list. Should you not wish to continue to receive WIPO media information releases after this event please check the following box. □ ATTENDANCE DATES: Date of arrival: Date of Departure: PLEASE FAX YOUR ACCREDITATION FORM AND SUPPORTING DOCUMENTATION TO THE WIPO PRESS OFFICE AT +41 22 338 8280 AT LEAST TWO WEEKS PRIOR TO THE OPENING OF THE EVENT DIPLOMATIC CONFERENCE FOR THE ADOPTION OF A REVISED TRADEMARK LAW TREATY SINGAPORE March 13-31, 2006 MEDIA ACCREDITATION PROCEDURE No media badge will be issued by the WIPO Press Office to journalists whose application does not conform to the established procedure. APPLYING FOR MEDIA ACCREDITATION The accreditation procedures for the Diplo