2008 Woodie Awards
Register for the Minorities in the Media Conference
Participation Form
Andrew Sison
Issue date: 12/16/05 Section: Media Conference
- Page 1 of 1
PARTICIPATION FORM - Priority deadline Friday, March 3, 2006
Name of High School: ___________________________________________________
High School City: _______________________________________________________
Contact Name: _________________________________________________________
Contact Phone: _______________________Contact E-mail: ____________________
Participants will have a choice between two unique media tracks:
* Track 1: radio, print, and Web media
* Track 2: television and public relations
Space is limited to 150 participants including high school staff. In order to allow participation from a number of high schools, we are limiting each high school to 15 total participants including high school staff and chaperones. If you have more students who wish to participate, please let us know and we will contact you if space allows.
Please list all participants including students, high school staff and chaperones. Circle a preferred track for each student.
1. _________________________________ Track 1 Track 2
2. _________________________________ Track 1 Track 2
3. _________________________________ Track 1 Track 2
4. _________________________________ Track 1 Track 2
5. _________________________________ Track 1 Track 2
6. _________________________________ Track 1 Track 2
7. _________________________________ Track 1 Track 2
8. _________________________________ Track 1 Track 2
9. _________________________________ Track 1 Track 2
10. _________________________________ Track 1 Track 2
11. _________________________________ Track 1 Track 2
12. _________________________________ Track 1 Track 2
13. _________________________________ Track 1 Track 2
14. _________________________________ Track 1 Track 2
15. _________________________________ Track 1 Track 2
Please contact Andrew Sison if you have any questions at (815) 836-5250 or at admissions@lewisu.edu. Fax this form to (815) 836-5002.
Name of High School: ___________________________________________________
High School City: _______________________________________________________
Contact Name: _________________________________________________________
Contact Phone: _______________________Contact E-mail: ____________________
Participants will have a choice between two unique media tracks:
* Track 1: radio, print, and Web media
* Track 2: television and public relations
Space is limited to 150 participants including high school staff. In order to allow participation from a number of high schools, we are limiting each high school to 15 total participants including high school staff and chaperones. If you have more students who wish to participate, please let us know and we will contact you if space allows.
Please list all participants including students, high school staff and chaperones. Circle a preferred track for each student.
1. _________________________________ Track 1 Track 2
2. _________________________________ Track 1 Track 2
3. _________________________________ Track 1 Track 2
4. _________________________________ Track 1 Track 2
5. _________________________________ Track 1 Track 2
6. _________________________________ Track 1 Track 2
7. _________________________________ Track 1 Track 2
8. _________________________________ Track 1 Track 2
9. _________________________________ Track 1 Track 2
10. _________________________________ Track 1 Track 2
11. _________________________________ Track 1 Track 2
12. _________________________________ Track 1 Track 2
13. _________________________________ Track 1 Track 2
14. _________________________________ Track 1 Track 2
15. _________________________________ Track 1 Track 2
Please contact Andrew Sison if you have any questions at (815) 836-5250 or at admissions@lewisu.edu. Fax this form to (815) 836-5002.
