Your Name: Age:

Current assignment:

Newspaper or Station:

Mailing address:

City: State: ZIP:

Email:

Phone:

Cell Phone:

Which of the following
best describes you? African American Asian Hispanic
Native American White/Caucasian

Experience:

Career expectations:

Why I want to attend:

What improvements would you recommend for editorial pages/broadcast commentary?

How did you hear about the seminar?

Attach your resumé: