WE ARE MEDIA! REGISTRATION

WE ARE MEDIA! Registration Form

November 25-27
At OYBM Media Center & Taala Hooghan Infoshop
1700 N. 2nd St. Flagstaff, AZ

Registration:
FREE for youth who pre-register/$5 day of (up to age 25)
$10 pre-registration for adults/$15 day of
Registration is required.

Click here to download and print the WE-ARE-MEDIA-registration form

or fill out the one below:

WE ARE MEDIA! Registration Form

1. Application type
2. Adult (over 25) Youth
3. Your Name(required)
4. Organization (if applicable)
5. Email(valid email required)
6. Street Address(required)
7. City/State/Zip(required)
8. Phone number(required)
9. Name & phone number of parent or legal guardian if under 18(required)
10. Age(required)
11. Gender
12. Female Male Transgender
13. Ethnicity
14. Check here if you want to be considered for a scholarship.
15. Payment options (waived for youth who pre-register)
16. Cash or check at OYBM Center Cash or Check DAY OF I'll Mail it in

 

cforms contact form by delicious:days

A limited number of travel reimbursement & accommodation scholarships may be available for attendees. Scholarships will be awarded on a first-come first-served basis. We will not be providing accommodations for everyone.

You can print and mail your registration form with a check payable to: Outta Your Backpack Media.
You can also bring your payment and registration form to OYBM Center 1700 N. 2nd St. Flagstaff, AZ 86004. You can also pre-register and bring payment day of.
E-Mail: oybm@oybm.org

You will receive a confirmation e-mail with directions, an agenda, and other details. Lunch is included on Saturday.
Questions? Call or e-mail WE ARE MEDIA! coordinators:
oybm@oybm.org – (928) 380-2629
We look forward to seeing you in Flagstaff!

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