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KEMPA SJW Camp Registration 2018
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Email
*
Your answer
Home Address
*
Your answer
Student Cell Phone Number
*
Your answer
Twitter Handle
Your answer
Birthdate
*
Your answer
Grade in Fall
*
Your answer
Sex
*
Male
Female
T-Shirt Size
*
Small
Medium
Large
XL
XXL
XXXL
Parent/Guardian's Name
*
Your answer
Parent/Guardian's Cell Phone Number
*
Your answer
SCHOOL INFORMATION
School Name
*
Your answer
School Phone Number
*
Your answer
School Address
*
Your answer
ADVISER INFORMATION
Adviser's Name
*
Your answer
Adviser's E-Mail
*
Summer e-mail is preferred
Your answer
Adviser Phone Number
*
Your answer
MEDIA STAFF INFO
Media Name
*
Newspaper/Magazine/Yearbook/Broadcast/Website Title
Your answer
Staff
*
Select all that apply.
Newspaper
News or Feature Magazine
Yearbook
Website
Broadcast
Literary Magazine
Required
Are you a KEMPA member publication?
*
Yes
No
Is your media a class or a extracurricular?
*
Class
Extracurricular
List the journalism classes and/or camps you've participated in previously. If you haven't attended another camp or had a journalism class prior, please write "none."
*
Your answer
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