NorCal Media Day Registration

You only need to complete this form once for ALL the students advised by the same JEANC member at the same school. Advisers must be members of JEANC to register for NorCal Media Day. If you are not on the drop-down list, then your membership has lapsed on July 31 or earlier. Please visit this page to join JEANC or renew your membership before registering for NMD. If you believe an error has been made, email: t a [email protected] (without spaces) with "Media Day" in the Subject line. Note: It may take up to 24 hours after registering for your name to appear on this list.

"*" indicates required fields

JEANC Member's Name*

Adviser's Email*

Adviser's Cell Phone*

(###) ###-####

About Your School

Name of School*

Are you working at a new school this year?*

Yes

School Address*

Street Address Address Line 2 City State ZIP Code

About Your Publication(s)

Name of Publication Advised*

Name of Second Publication

Leave blank if you do not advise an additional publication.

Name of Third Publication

Leave blank if you do not advise an additional publication.

Name of Fourth Publication

Leave blank if you do not advise an additional publication.

Who is Coming?

Chaperone's Name

If you will be bringing a chaperone, please supply the individual's FIRST and LAST name.

Chaperone's Cell Phone

(###) ###-####

This chaperone is attending

instead of the adviser.

as a co-adviser.

as an additional chaperone.

Additional Chaperone's Name

If you will be bringing an additional chaperone, please supply the individual's FIRST and LAST name.

Additional Chaperone's Cell Phone

(###) ###-####

This chaperone is attending

instead of the adviser.

as a co-adviser.

as an additional chaperone.

Names of Students Attending*

Please list all of the students who will be attending NorCal Media Day by their FIRST and LAST names, using a comma to separate individual students. (Do NOT hit "Return" as it will submit the form.) We will generate NAME TAGS from this list, so please ensure that preferred names are spelled correctly.

Total Number of ADULTS Attending*

Please enter a number from 1 to 100.

Total Number of STUDENTS Attending*

Please enter a number from 0 to 100.

Phone

This field is for validation purposes and should be left unchanged.