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Registration: Multiple Registrations

Note: This form should only be used if you are signing up multiple people and using the same credit card to pay for all fees. To register instead as an individual, go here.


Organization/Company Information

Organization/Company Name:
Mailing Address:
City:
State:
ZIP:
Your E-mail:
In case we need to contact you. You will also receive a receipt at this e-mail address.

Registration   See pricing plans (opens in new window)

Please Note:
— You may register up to 10 people at a time with this form. (If you have fewer than 10, leave the remaining fields blank.)
— Please feel free to use this form as many times as needed if you need to register more.
— A unique email address and phone number must be used for each person.
— Registrants marked as members (with an accompanying membership number) will receive the membership rate, while those not designated as members will receive the non-membership rate. At least one membership number – for SPJ, RTDNA or NAJA – is required for each registrant in order for that registrant to receive the membership rate.


Registrant #1
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Name:

Title (if applicable):
Twitter Handle:
Your Twitter handle will be printed on your nametag. Only Twitter handles collected on this registration form will be included. Handles cannot be added to registrations/name tags at a later date. Leave blank if you do not want your Twitter handle on your name tag.
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #2
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #3
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #4
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #5
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #6
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #7
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #8
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #9
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Registrant #10
See pricing plans (opens in new window)

Name:

Title (if applicable):
Twitter Handle:
@
Phone:
E-mail:
Does this person have buying power in his or her newsroom?
Yes No
This person currently is a:
Professional Member of SPJ/RTDNA/NAJA
Professional Non-Member
Student Member of SPJ/RTDNA/NAJA
Student Non-Member
Retired Member of SPJ/RTDNA/NAJA
Retired Non-Member
This person currently is a member of:
Check all that apply. Please note that you must supply at least one membership number immediately below to receive the membership rate.
SPJ
RTDNA
NAJA
SPJ Member Number (if applicable):
RTDNA Member Number (if applicable):
Meal Tickets for this person:
RTDNA Paul White Award Reception: x $45 per ticket
SPJ President's Installation Banquet: x $80 per ticket
NAJA National Native Media Awards Banquet: x $80 per ticket
Please mark one of the following:
American Indian or Alaska Native
Asian
Black or African-American
Hispanic or Latino
Arab or Middle Eastern
Native Hawaiian or other Pacific Islander
White

Tours and Additional Events

Registration for tours is not available via this form. Attendees who wish to sign up for a tour or other special event may use the individual registration form and select the "I am registering only for a workshop, meal or other event at this time" option.


Donations

Radio and Television Digital News Foundation: Make a tax-deductible contribution to the foundation of RTDNA, the Radio and Television Digital News Foundation. RTDNF’s programs are supported entirely by charitable contributions.

RTDNF Donation:
$

Society of Professional Journalists: Make a tax-deductible contribution to the foundation of SPJ, the Sigma Delta Chi Foundation. The SDX Foundation provides educational programs to the journalism community.

SDX Foundation Donation:
$

Native American Journalists Association: Make a tax-deductible donation to the general fund of NAJA to support missions of the organization.

NAJA Donation:
$

Method of Payment

Credit Card Type:
MasterCard
American Express
Visa
Credit Card Number:
(Enter without spaces)
Credit card security code:
Three or four digits, on the back of the card
Expiration date (MM/YY):
Name as appears on card:
Cardholder's e-mail:

Cancellation Policy: All refund requests must be made in writing to lsusemichel@spj.org. No requests made by telephone will be accepted. Cancellation requests made before September 4 are subject to a $50 processing fee. No refunds will be made after September 4.

Complete this form and click the "Continue" button to review your selections and see the total amount due.


Questions about the Excellence in Journalism 2016 Conference?

Call 317/927-8000 or send an e-mail to convention@spj.org.

 

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Eugene S. Pulliam National Journalism Center
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Indianapolis, IN 46208
317/927-8000 | Fax: 317/920-4789

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