Broadcast Education Association
2002 Faculty or Student Interactive Multi-Media Competition Entry Form
Your Name:________________________________ Co-workers: ________________________________ Name(s)/Title for awards certificate:________________________________ Business Phone : ______________________________ Home Phone : ______________________________ Fax Number : ______________________________ Mailing Address: ______________________________ City:_________________State:_______Zip:_____________ e-mail address :_________________________________ Institution/School/Organization: ______________________________ Title of Program: ______________________________ Completion Date: ______________________________ Your role in the program: ______________________________ Media Category (Check one only) _____ ONLINE: _____ WWW _____ FIXED MEDIA: Please indicate the medium the program was created on or distributed with.
(CD-ROM is the required format for submission in the fixed media category)
Program details (In the spaces provided, briefly describe your program): Intended Purpose(s): *Make checks payable to Broadcast Education Association (BEA). ________ I have labeled all submissions with a program name, my name, address, and e-mail. ________ Enclosed is a self-addressed stamped mailer for the return of my entry (optional). ________ I will pickup submitted materials at the convention. ________ No need to return submitted materials. I hereby affirm that I, or my organization, own or have legal clearances to this program. Further, my organization and I hold the Broadcast Education Association harmless for any and all suits or liabilities arising from any alleged or actual violations of copyright or loss of programs submitted. I also give my permission for my entry to be screened, in whole or in part, at the 2002 Broadcast Education Association Convention in Las Vegas. Your signature:_______________________________ Date:____________________________________ Submit all Faculty entries and support materials (incomplete packets will not be judged) Postmarked no Later than Saturday, December 1, 2001 to: William Snead Faculty IMM Competition questions: William Snead: (619) 644-7289 Submit all Student entries and support materials (incomplete packets will not be judged) Postmarked no Later than December 1, 2001 to: Colin Chambers Street Address for UPS shipments: Student IMM Competition questions: Colin Chambers: 01 (782) 294485
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