Student Reservation Form

For which workshop would you like to register? Since they are all July 27-31, you may only choose one.
Newspaper Yearbook Photojournalism Broadcast Publication Design and Redesign Web Site Design
See Fees Table to determine payment for your selected workshop. Payment (must be sent by June 20) Please select correct fee: $395 $435 $445 $475 $485 $495 $325 $365 $375 $415 $425

Student's First Name: Last Name:
Street Address:
City:
State: Zip:
Home Phone: Email Address:
Student's gender: female male
Student's year of graduation 2006 2007 2008 2009 2010 2011 2012 (Students who have just completed grades 8, 9, 10, 11 or 12 may attend the Workshops.)

School Name:
School Street Address:
City:
State: Zip:
School Phone:
Adviser:

Roommate Request:
Roommate requests will be honored when possible. Students who do not make a request will be matched with students who are of the same gender, are in the same age range and attend different schools to provide workshoppers with a broader social experience.

Remember, this form will save you a spot in a Workshop, but you must still send the UI Summer Journalism Workshops three things:
      1) The completed and signed Medical Form (print as a PDF document).
     2 ) The completed and signed Liability Form (print as a PDF document).
     3 ) Payment. (See fees table to determine what your payment should be.)
Payment, Medical Form, Liability Form, and Student Reservation Form must be received by June 20. To get our special early bird reservation rates, electronically send the Student Reservation Form before June 1 (payment and additional forms must still be reserved by June 20).

Refunds can be made without penalty only until July 1. No refunds will be made once the Workshops begin.

After submitting this form, please print the page that appears for your records.