Media Arts Registration

CAPITAL REGION MEDIA ARTS 2009 FESTIVAL & COMPETITION Registration Due Friday, January 16, 2009

High School *

District COORDINATOR *

Email *

Phone Number *

Fax Number

Chaperoning Teacher(s)

Street Address *

Address continued

	City	State	Zip

	VideoArt Form(s) Entering
	VideoPhotographyComputer Generated ArtWeb DesignOriginal Electronic Composition

Participation Fee *Bill through BOCES (need district authorization)Check will be sent Payable to Capital Region BOCES

Method of Payment:
Bill through BOCES (need district authorization)
OR
Check Payable to Capital Region BOCES

Mail check to:
Capital Region BOCES
c/o Mindy Iannotti
900 Watervliet-Shaker Road, Suite 102
Albany, NY 12205