Diversity Workshop Registration

Thank you for your interest in registering for
CMA Diversity workshop!

Please take note of this important information before you complete this form:

• There are a limited number of spots available for this workship.

• You may make payment at time of registration using any credit card via our processor PayPal. You do not need a PayPal account to pay by credit card. You may also pay by check by clicking that choice on the "select payment method" page and printing a copy of your order from the confirmation page. All checks should be mailed to: CMA, 355 Lexington Avenue, 15th Floor, New York, NY 10017.

• There will be no refunds for completed registrations for any reason, however, you may substitute attendees for anyone unable to attend.

Questions: Contact info@collegemedia.org or call 212-297-2195.

Please note that CMA utilizes PayPal merchant services to securely accept payments with
VISA, MasterCard, American Express, and Discover cards, or PayPal funds transfer.
You are not required to access or obtain a PayPal account to process payment.

Please provide information below for an individual registrant or for the primary contact for a group registration:

College or University name (non-school affiliates list business name or "none"): *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Cell Phone Number *

Email Address *

I am a student member of Orange Media Network at Oregon State University.

Yes

Please enter the total number of registrations for each category below. All registrations are $99 per person for early bird (before September 9) and $109 regular pricing (after September 9).

	CMA Member Registration ($109)
	Student Registration ($109)
	Non-CMA Member Adviser/Professional Registration ($109)

If any of your attendees have any dietary restrictions, please list their names and restrictions here:

Current Total:

$0.00

In the blocks below please list the names of your attendees. If you are registering more people than there are spaces provided on this form, email info@collegemedia.org with the additional names.

Name of Attendee #1

EMAIL ADDRESS: Attendee #1

Name of Attendee #2

EMAIL ADDRESS: Attendee #2

Name of Attendee #3

EMAIL ADDRESS: Attendee #3

Name of Attendee #4

EMAIL ADDRESS: Attendee #4

Name of Attendee #5

EMAIL ADDRESS: Attendee #5

Name of Attendee #6

EMAIL ADDRESS: Attendee #6

Name of Attendee #7

EMAIL ADDRESS: Attendee #7

Name of Attendee #8

EMAIL ADDRESS: Attendee #8

Name of Attendee #9

EMAIL ADDRESS: Attendee #9

Name of Attendee #10

EMAIL ADDRESS: Attendee #10

Name of Attendee #11

EMAIL ADDRESS: Attendee #11