SALUTATION * FIRST NAME * LAST NAME * NAME OF MEDIA OUTLET (Trade Bulletin, Magazine Etc.): * Profile of Publication / News Media JOB TITLE: * ORGANISATION NAME: * CITY * POSTAL CODE COUNTRY * TELEPHONE * (CountryCode) - (AreaCode) - (Number) (CountryCode) - (AreaCode) - (Number) FAX * WEBSITE EMAIL * Media Registration Form Media Coverage ADDRESS * Personal particulars: TITLE OF PUBLICATION: MEDIA TYPE (Print/Radio/Television/Internet/Others): NATURE OF PUBLICATION (Consumer/Business/Trade and Tourism/ MICE/others): READERSHIP PROFILE: a) Top 3 industry sectors b) Top 3 geographical areas CIRCULATION: FREQUENCY OF PUBLICATION: PLEASE WRITE DOWN YOUR PUBLICITY COVERAGE PLAN FOR ITE HCMC 2010. 1) Proposed publicity coverage plan for ITE HCMC 2010: Other Comments/Enquiries If you have other comments or enquiries, please write them down here: