IBS New York City REGISTRATION
FORM - Walk In Registration is OK!
Pay by major credit
card (VISA-MasterCard-Discover)
The Big Benefits of
pre-registration are that YOUR ID badges will be ready, no waiting in line,
FREE lunch
IBS/CUNY Kingsborough Community College
Media Conference
Saturday, October 27, 2012
Kingsborough Community
College
2001 Oriental Blvd.
Brooklyn, NY 11235
Intercollegiate Broadcasting System, Inc. (IBS)
367 Windsor Highway, New Windsor, NY
12553-7900
Phone: 845 565-0003
FAX: 845-565-7446
email: IBSHQ@aol.com
Please print
clearly, or type, this form and mail with your payment check.
Or pay by major credit card
(VISA-MasterCard-Discover)
call IBS 1-845-565-0003!
(Advance FAX to
845-565-7446 for quick confirmation.
Return FAX confirmation to: ________________)
Registration is
$45 per person. IBS Federal ID is: 23-705-9805
Station Name/Call Letters:
___________________________________________
School
Name:_____________________________________________________
Station email address:
_____________________
Station mailing address:
__________________________ State: __ Zip ________
Registration fee: IBS member stations: ___ $45
per person; Non-member
stations: ___ $95 p/p
Our payment check for _____ people in the amount of $______________
is enclosed or has been, or will be sent to:
Mail to: IBS, 367 Windsor Highway, New
Windsor, NY 12553-7900
Please register the following
people (please print clearly or YOUR Badge will be wrong):
Person #1
First
Name:_________________ Last Name: ___________________
Person's
Station Job Title for Badge: _________________________
------------------------------------------------------------------
Person
#2
First
Name:_________________ Last Name: ___________________
Person's
Station Job Title for Badge: _________________________
------------------------------------------------------------------
Person
#3
First
Name:_________________ Last Name: ___________________
Person's
Station Job Title for Badge: _________________________
------------------------------------------------------------------
Person
#4
First
Name:_________________ Last Name: ___________________
Person's
Station Job Title for Badge: _________________________
------------------------------------------------------------------
Person
#5
First
Name:_________________ Last Name: ___________________
Person's
Station Job Title for Badge: _________________________
------------------------------------------------------------------
Person
#6
First
Name:_________________ Last Name: ___________________
Person's
Station Job Title for Badge: _________________________
------------------------------------------------------------------
Person
#7
First
Name:_________________ Last Name: ___________________
Person's
Station Job Title for Badge: _________________________
------------------------------------------------------------------
Person
#8
First
Name:_________________ Last Name: ___________________
Person's
Station Job Title for Badge: _________________________
------------------------------------------------------------------
Person
#9
First
Name:_________________ Last Name: ___________________
Person's Station Job Title for Badge:
_________________________
Available area hotel/motel lodging within a
five-minute drive from the conference are:
1. Best Western
3003
Emmons Ave
Brooklyn, NY 11235
2. Comfort Inn
3218 Emmons
Ave
Brooklyn, NY 11235