1. Name and Contact Details:

                 Mr/Mrs/Miss:    Initials:   Surname:

                  Job Title:       

                  Company:     

                  Address:       

                  Postcode:        

                  Country:        

                  Telephone:         

                  Fax:                 

                  Email:                

 2. What is your primary job function? 

                                                     CEO/MD            

                                                               Operational Management

                                                               Technical Management

                                                               Sales/Marketing mangement

                                                               Other (please specify)  

 3. What category best fits your organisation?

                    Cable Operator                            Consultant                            Equipment Supplier

                    Films                                            Gaming Industry                    Industry Body

                    ISP                                              MNO                                   MSO

                    Music Industry                             Pay TV Platform                   Private Broadcaster

                    Professional                                 PTT/PTN Operator               Public Broadcaster

                    Publishing                                     Radio                                   Regulator   

                    Satellite Operator                         Services Supplier                  Software

                    TV Producer                                Video Games                       Other ( please specify below )

 4. Are you personally responsible for purchasing/recommending/specifying/authorising or influencing the purchase of equipment, services or rights for your company?        

                                                                            Yes            No

 5. Personal verification information - please answer one of the questions below:

                                                                        Your mothers maiden name:  

                                                             or        Your home town:                     

* Incomplete cards will not be processed                           

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