32nd Journalism  Opportunities Conference
PARTICIPANT REGISTRATION FORM
October 14-15, 2010 •  USC Davidson Conference Center •  Los Angeles, CA 90089

Please fill out form, then print and mail or fax to CCNMA
NAME:
ADDRESS:
   
CITY:
  STATE:    ZIP:
PHONE:
  EMAIL:  
SCHOOL/COMPANY:
ADDRESS:
CITY:
  STATE:    ZIP:  
DAY PHONE:
Dates Attending: Thurs. (10 a.m. - 5 p.m.) Fri. (10 a.m. - 5 p.m.)
Attending Friday lunch: Yes No
I have special needs: 
Ethnicity (for statistical purposes only):
African American Asian Latino Native American Other
GENDER: FEMALE MALE

STUDENTS ONLY
School year: Sophomore Junior Senior Graduate
Major: Exp. graduation date:
Internships (include dates):
PROFESSIONALS ONLY
Experience: 1-2 yrs. 3-5 yrs. 5+ yrs.

Medium: Print TV Radio Wire On-line
Beats covered:
ALL APPLICANTS
Job Preferences: Internship Part-time Full-time

Medium Preference:  Print TV Radio Wire On-line
Position Preference:
     PRINT:
Reporter Editor Copy Editor
Graphics Photography Management
     TV/RADIO:
Reporter Anchor Producer
Writer Videographer/Sound Tape Editor
Graphics Assignment Editor Management
FIELDS:
News Business Sports
Entertainment Features Other: 
NON-EDITORIAL POSITIONS
Sales Circulation Advertising
Promotions Finance/Accounting Production
Human Resources Engineering Public/Community Relations
Other:

METHOD OF PAYMENT
Registration received prior to Sept. 13, 2010, is:

 MEMBERS* NON-MEMBERS
STUDENTS $50 $60
PROFESSIONALS $75 $85
*For members of CCNMA, NAHJ, AAJA, NAJA, NABJ or NLGJA.  Please include proof of membership with your payment.
Registration received after Sept. 13, 2010, regardless of membership affiliation is:
STUDENTS $75
PROFESSIONALS $100

Check made payable to CCNMA enclosed. 
Bill my credit card:

 American Express  Mastercard  Visa

Account number:

Name on card (print):  

Expiration date:

Signature:_______________________________________________
Total Enclosed: 
Mail registration to:
CCNMA/JOC • USC Annenberg School of Journalism • 727 W. 27th St., Room 201  • Los Angeles, CA  90007-3212
FOR OFFICE USE ONLY
Application Received_______________ Check or Money Order No.  __________________ Entered in Computer_____________