National Venture Conference 2009 Media Registration

Please complete the following form. Fields marked with an asterisk (*) are required. When you hit the "Submit Request" button, you should shortly receive an e-mail to confirm receipt of your request. Please note that this e-mail will only confirm receipt of your request. We will contact you again by email regarding the status of your request for press credentials.

If you do not receive an email confirmation, or a follow-up email regarding your status, please verify that the messages have not been caught by your company's "spam filter" before requesting that BIO resend the message.

First Name & MI*:	*required
Last Name, Suf.*:	*required
Professional Title*:	*required
Publication*:	*required
Type*: *required	Magazine,   Newspaper,   Newsletter Online,   Radio,   Television Other:
Web Site*:
	*If you selected 'online' as your publication type, you must provide the web site address for the publication.
Suite:
Address*:	*required
City*:	*required
State/Province:
Postal Code*:	*required
Country:
E-mail*:	*required
Phone*:	*required
Fax:
	Freelancer
	If you are a freelancer, please provide the following information regarding the publication that has assigned you to cover this event.
Assignment Editor:
Phone:
	It's okay for presenting companies and conference sponsors to contact me about news related to the conference.
	I would prefer not to receive news from presenting companies and conference sponsors.
	* Note: if you are a freelance journalist, submitting this form does not complete your application. Please have your assignment editor send a confirmation letter to BIO before Wednesday, March 25, 2009. The letter must be on the news organization's stationery and have complete contact information. Please send the letter to: Erin Reese, Biotechnology Industry Organization, 1201 Maryland Avenue, SW, Suite 900, Washington, DC 20024; or Fax 202-488-6304.