1 digiquest 2011 registration form - Midpeninsula Community Media ...

DIGIQUEST 2011 REGISTRATION FORM
| |
Name of Participant (Please Print Plainly. One Participant Per Form) Age
|
Address
|
City, State, Zip
| |
Phone Email
| |
School Grade
Please register me for the following session(s):
__ June 20-24 TV Studio Production 1 __ June 27-July 1 TV Studio Production 2
__ July 25 – 29 – Advanced Animation
To Register for Movie Production or Digital Video Editing, contact Lee Anne Campbell at the
Palo Alto Art Center. Leeanne.campbell@cityofpaloalto.org
All sessions run from 9:30 am – 3:30 pm. Bring your own lunch; Snacks, juice and bottled water will be provided.
|
Name of Parent or Guardian of Participant (Please Print Plainly)
|
Address
|
City, State, Zip
| |
Contact Phone During Camp Email
|
Signature of Parent or Guardian
Fee: $495 for TV production. $420 all other sections.
Special discounts available. Please indicate below, if applicable:
__ 10% off for multiple weeks ($420 for 1 st week; $400 for each additional week)
__ 10% off for multiple family members ($420 for first camper, $400 for each sibling)
Early Bird Registration: If received by May 1 st , get one free studio rental to make your own show.
Total Amount: __________ Date: _____________
Total Amount: ____________ Date:____________________
Method of Payment: ___Check made Payable to: “Media Center”
Method of Payment: ___ Check (made payable to: “Media Center”) | Check #: __________
| | Visa | | Mastercard | | | |
(Circle
(Circle
One)
One)
Credit
Credit
Card
Card
#
#
Expiration Date
Expiration Date
| |
Cardholder’s | Name Complete Credit | Card Billing Address (No P.O. Boxes
|_____________________________________________|___________________________________________________
Card Holder’s Name Complete Credit Card Billing Address (No P.O. Boxes)
___________ | |
Cardholder’s Card Holder’s Signature City, Sate, City, Zip State, Zip
Please tell us how you found out about Digiquest:
__ Media Center Website __ Media Center Flyer
__ Media Center TV Promo __ Email Notice (From Whom?)
__ Internet (Which Site?) __ Newspaper Ad (Which Newspaper?)
__ Word-of-Mouth __ Other: ___________________________
See page 2 for fee payment and cancellation policy
Media Center • 900 San Antonio Rd • Palo Alto, CA 94306 • 650 494-8686
1

Digiquest Fee Payment and Cancellation Policy:
The full fee of $420 (less applicable discount for multiple sessions or
sibling sign-up) confirms your registration.
In order to receive a refund due to cancellation, written notice* must be
received no later than 5 PM on the dates listed below:
Start Date: Refund of 85%: Refund of 50%: No Refund:
June 20 by May 20 by June 5 after June 5
June 27 by May 27th by June 11 after July 11
July 11 by June 11 by June 17 after June 17
July 18 by June 18th by June 28 after June 28
• If you cancel up to four weeks before the session begins, we will
refund 85% of the fee.
• If you cancel between two and four weeks before session begins, we
will refund 50% of the fee.
• If you cancel less than two weeks before the session begins, there is
no refund.
*Written notice may be sent to:
Email: Brad@midpenmedia.org
Fax: (650) 494-8386
Mail: Brad Sanzenbacher, Digiquest Director
c/o The Media Center
900 San Antonio Road
Palo Alto, CA 94303
Other Important Information:
• We reserve the right to cancel a session if enrollment is insufficient.
In this instance, any fee paid will be refunded in full.
• The Media Center is not responsible for any lost, damaged or stolen
personal belongings.
2