The Press Area

WWW5

Fifth International World Wide Web Conference

May 6-10, 1996, Paris, France

Media Accreditation Form


Please, print and complete this form after having read carefully the instructions and procedure and returned to:

Fifth International World Wide Web Conference - PRESS OFFICE
Ms Jackie Phillips
Andrew Lloyd & Associates, Ltd.
Brighton Business Center
95 Ditchling Road
Brighton BN1 4ST
United Kingdom

Tel: +44 1273 675 100
Fax: +44 1273 675 400

E-mail: allo@ala.com

[]Please use block letters only

When using electronic mail, please, copy this text only version of the accreditation form.


Mrs |_|   Ms |_|   Mr |_|

NAME:       |_____________________________________

FIRST NAME: |_____________________________________

TITLE:      |_____________________________________

CATEGORY (please check):

Trade Press             |_|  Daily Press              |_|  TV Station     |_|
Economic/business Press |_|  Technology Correspondent |_|  Radio station  |_|
                        |_|  Business Correspondent   |_|  Press agency   |_|
                                                           Photographer   |_|

NAME OF PUBLICATION/PRESS AGENCY/RADIO STATION:

            |_____________________________________

NAME OF TV STATION:

            |_____________________________________

ADDRESS OF PUBLICATION/RADIO OR TV STATION/PRESS AGENCY:

            |_____________________________________
            |_____________________________________

COUNTRY:    |_____________________________________

ADDRESS WHERE DOCUMENTATION SHOULD BE SENT IF DIFFERENT FROM ABOVE:

            |_____________________________________
            |_____________________________________

COUNTRY:    |_____________________________________

TELEPHONE:  |_____________________________________
            (country code, area code, telephone number)

FAX:        |_____________________________________
            (country code, area code, fax number)

E-MAIL:     |______________________________________
            (Internet format)


For TV journalists, please indicate the name and title of accompanying staff (director, cameraman, technician, etc.), if any. Use additional sheets if required: NAME: |_____________________________________ FIRST NAME: |_____________________________________ TITLE: |_____________________________________
I would like documentation in English/French E |_| F |_| I intend to cover (please check): the Tutorials |_| the Technical Program |_| the SMEs Forum |_| the Developer's Day |_| the Exhibition |_| I intend to be at the Fifth International World Wide Web Conference on the following day(s): May 6 |_| May 7 |_| May 8 |_| May 9 |_| May 10 |_| I would like to have vegetarian meals: YES |_| NO |_| I do not want my personal information to be included in the public attendees list: YES |_| NO |_| DATE: SIGNATURE: