2008 SYMPOSIUM APPLICATION

Student's Name

 

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Home Mailing Address

 

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City, State, Zip

 

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College/University

 

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Your Address at School (if different)

 

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City, State, Zip

 

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Your Phone Number

 

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Your E-mail Address

 

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I am applying for admittance to the 2008 Broadcast Pioneers of Philadelphia Symposium. I understand that space is on a first come basis. I further understand that nothing can save my space until the Broadcast Pioneers of Philadelphia receives this completely filled in application and my check or money order for $20 per person made payable to "The Broadcast Pioneers of Philadelphia." Checks with insufficient funds will result in cancellation of your reservation without notice.

 

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Signature

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Date

Mail your payment to:

The Broadcast Pioneers of Philadelphia
Post Office Box 2886
Bala Cynwyd, PA 19004

(856) 365-5600