MediaCon Registration

School/organization name
Contact person Contact person First Last
School mailing address School mailing address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email

Confirm email address
School phone School phone - ### - ### ####
Mobile phone Mobile phone - ### - ### ####
I will be bringing the following (check all that apply)

I will be bringing the following (check all that apply) Teachers (Registration is free) Students (Registration is free)
Enter the total number of the teachers
Please include a complete list of attending teachers' names.
Enter the total number of the students
Please include a complete list of attending students’ names and their grade level.

Example:

Julie Andres, senior
Gene Kelly, junior
Carol Channing, sophomore
Alan Bennett, senior
To help us welcome students from a variety of schools across New Mexico and nearby areas, we may need to adjust the number of students each school is able to bring, depending on overall registration.

Please select one:

To help us welcome students from a variety of schools across New Mexico and nearby areas, we may need to adjust the number of students each school is able to bring, depending on overall registration. Please select one: I understand and agree. I do not agree.
We plan to include a Student Media Showcase where participating students can share their media work and receive feedback. Examples of media work include, but are not limited to, news articles, journalistic photographs, podcasts, audiovisual content, and public relations case studies.

Each student participating will also receive a small gift from ENMU’s Department of Communication.

Do you have any students who may be interested in participating in the Student Media Showcase?*

We plan to include a Student Media Showcase where participating students can share their media work and receive feedback. Examples of media work include, but are not limited to, news articles, journalistic photographs, podcasts, audiovisual content, and public relations case studies. Each student participating will also receive a small gift from ENMU’s Department of Communication. Do you have any students who may be interested in participating in the Student Media Showcase?* Yes No
Please provide any information available at this time about the potential submission(s).

For example, you may include the type of media work, a brief description of the work, and the name(s) of the student(s) who created it. It is fine if some details are not yet finalized.