CHI 99: Media Pre-Registration Form

Please complete the application below and submit required documentation via mail or fax by April 15, 1999.

This is not an online form -- please print it, fill it out, then fax or mail it to the address below.

Name:

Title:

Company:

Address:

City:

State:

Zip:

Country:

Phone:

Fax:

Email:

Check media in which you are active:

[  ] Television
[  ] Print
[  ] Radio
[  ] Online
[  ] Wire Service
[  ] Newsletter
[  ] Trade Publication
[  ] Freelance Journalist
[  ] Consumer Publication

Your URL:

How did you hear about CHI 99?

Requirements:

All applicants MUST also submit one of the following by mail or fax:

Your media outlet's masthead or stationary, with your name and editorial title
A bylined article written by you, on your publication's masthead, and published within the last 6 months
A letter from your editor, on your media outlet's stationary, stating that you are assigned to cover CHI 99.

Mail or fax your credentials to:

R. Stevens
CHI 99 Media Relations
c/o Ace Public Relations
366 Iris Way
Palo Alto, CA 94303

Fax: +1 650-494-2891