1

Surname

2

Name

3

Title

(Mr., Mrs, Ms. Dr. Prof., Other: please specify)

4

Occupation

5

Organisation

6

Designation

Industry

(film production ,broadcasting, advertising, banking, international agency, civil society, academic, government agency, other: please specify)

7

Street Address

8

State

9

Country

10

Company website

11

Email address

12

Telephone Number

13

Fax number:

14

Cell/GSM number

15

Special interests?

(please state the conference topic you are most interested in: intellectual property rights, development film, funding, case studies of innovative film case studies, investment opportunities, training, other: please specify)

16

Where did you learn about the conference?

(from the conference flyer, television advert, radio advert, poster, from a colleague/friend, from an email invitation, from a mailed invitation, from the internet, other: please specify)