World Of Health IT > Media Registration Form

Media Registration Form

Bold fields are required. Other fields may be required depending on a selection made as well.

Attendee Information

First Name
M.I.
Last Name
Nickname For Badge
Title
Publication
Address1
Address2
City
State/Prov.
Postal Code
Country
Phone
Mobile Phone
Fax
E-mail
Special assistance required? (please specify) Yes No

Registration Questions

Registration for general sessions, technical, panel and poster presentations plus entrance to the exhibit hall is complementary for members of the media who provide proper credentials.

Demographic Questions

What is the frequency of your publication?

General Audience?
Publisher's Name?
Approximate Circulation?
Working Language?

For Additional Information

Journalists in Europe can contact:

Jacqueline Bowman
World of Health IT
Marketing & Communications Project Manager
Avenue de Tervueren 300
B- 1150 Brussels - Belgium
E-mail
Phone: +32 472 54 45 78 (direct line)
Fax: +32 (0)2 743 1550