2019 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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PLEASE! PRINT AND MAKE SURE IT'S LEGIBLE!

I am applying for admittance to the 2019 Broadcast Pioneers of Philadelphia Symposium.I understand that nothing can save my space until the Broadcast Pioneers of Philadelphia received 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 and you will be billed for the bank charge. Please do not send cash!

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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