2016 Academic Membership Form
2016 ACADEMIC MEMBERSHIP FORM MEMBERSHIP TYPE AMOUNT DUE Mr. Ms. Academic $49.00* Name: *Must be a full time faculty staff or student. Title: Faculty: must provide current staff ID or other form of teaching verification at a college, university or high school. Student: Must proovide current student ID card and full time class schedule (minumum of 9 units). Organization: Address: PROMAXBDA: THE CONFERENCE 2016 City: State: June 14-16, New York Hilton Midtown Zip Code: Academic Registration $99.00 Phone: Fax: Email: Website: PLEASE CHECK THE APPROPRIATE BOXES IN THE 4 AREAS BELOW TO PROVIDE INFORMATION ABOUT YOU AND YOUR COMPANY CHECK ONE ONLY 1 CHANNELS (NBC, MTV, FOX, Canal+, MSOS/MVPDS (Comcast, Time ACADEMIC 3 JOB LEVEL BBC, A+E, etc) Warner, Star, DIRECTV, Virgin Media, etc.) Educator Executive Management (CMO, Cable Channel (MTV, Discovery, Bravo, Cable (Comcast, Time Warner, Virgin EVP, SVP, Managing Director, etc.) Student Disney Channel, etc.) Media, ONO, etc.) Senior Management (VP, Executive Broadcast/Terrestrial Network (NBC, ZDF, Satellite (DIRECTV, DISH, SKY, etc.) 2 DEPARTMENT/AREA Producer, etc.) CBS, BBC, DR, etc.) OF BUSINESS Game/Entertainment Console (Xbox, Director Pay TV/Subscription Channel (HBO, Playstation, etc) Marketing Mid-Level (producer, manager, etc.) Eurosport, LAPTV, Showtime, etc.) Internet (Hulu, iTunes, Youtube, etc.) On-Air Promotion Entry Level (assistant, coordinator, etc.) Satellite Channel (Audience Network, Mobile (AT&T, Orange, Verizon, etc.) Creative Services ARTE, DW-TV, etc.) Programming 4 JOB
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