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November 15, 2006

Speaker/Presenter Registration

Deadline for Registration is February 16, 2007

CONTACT INFO:

First Name
Last Name
Organization Affiliation
Title
Home Phone
Business Phone
Cell Phone
Fax
E-mail address
Emergency Contact
Relation
Contact's Phone
Contact's Cell Phone

BIO:

WORKSHOP/PANEL:

I CAN present on: Friday, October 21: Morning Afternoon

I CANNOT present on:

EQUIPMENT (laptops will NOT be provided, contact us if needed):

I need:

TV/VCR
LCD Projector/Screen
Other

TRAVEL:

I need ARC to make travel arrangements.

  

I would like to fly out of: or:
I would like to fly into New York or Newark on:


My earliest departure time would be
(please specify AM or PM):
My latest departure time would be
(please specify AM or PM):
I would like to fly out of New York or Newark on:


My earliest departure time would be
(please specify AM or PM):
My latest departure time would be
(please specify AM or PM):

HOUSING:

Unless specified - ARC will provide shared-double rooms at a local New York hotel:

I need ARC to make my housing arrangements:    

I need a room that's:

Do you require any special housing needs?

MEDIA:

Are you willing to speak to the press?    

I can speak to the media in: English   Spanish   Arabic  Other
Specify if other:

 

I know reporters who would like to know more about the conference:

Name:
Outlet:
Phone:
E-mail:

 

Name:
Outlet:
Phone:
E-mail:



 

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