We want this experience to be GREAT for you, so take a few minutes to fill out the information below!
Name: ______________________________ Date Of Birth: ___ / ___ / ________
School: ___________________________________________
Class: FRESHMAN SOPHOMORE JUNIOR SENIOR My Phone Number: (___) ____ - ______
E-mail Address: ______________________________________
What are your career aspirations? __________________________________________________
Select three media in which you could contribute to reACT: WITF’s Next Gen Network:
TV | Radio | Magazine | Web | Public Relations | Sales | Fundraising | Graphic Design
1.__________________ 2.__________________ 3.__________________
Very Interested Interested Somewhat Interested
Have you visited WITF’s Public Media Center? YES NO
Would you like to take a tour? YES NO
I authorize WITF to use, in whole or in part, my name, image, voice, and performance in connection with reACT: WITF’s Next Gen Network, in all manner and media, as WITF shall determine in its sole discretion. If you are under 18 years old, you must have a parent or guardian sign the bottom portion of this release form.
Name: __________________________________ Signature:____________________________________ Date: ____________
Parent/Guardian: _____________________________ Signature:___________________________ Date: ____________
Thank you for your interest in reACT: WITF’s Next Gen Network!
