MOXIE SCHOOL TV • VIDEO • BROADCAST SIGN UP • UPDATE FORM


***PLEASE NOTE: We DON'T sell/give out your email, or use it to send you cyberjunk. We DO use it to keep you posted on music, opportunities with artists (interviews, concert reviews, shows @ your school) & other things as they come up.

PLEASE give it if you have it, as it's an important way we keep you informed of stuff.

School


Address


City, State, Zip


Closest City


Station Call Letters OR name of TV/broadcast program


Check any and all of the following that applies. Your Station is:
Local Community Cable
In-School Broadcast Only
School District Cable
Other

If other, please describe/explain


Phone with area code


Faculty Advisor is:


Faculty Advisor email; include more than one if applicable:


Student if any, we should be in contact with regarding music:


Student grade


Student email*

OTHER SCHOOL STUDENT ORGANIZATIONS INFO

We would like to extend our record service to other student organizations in your school if you think they would welcome it and/or could make use of it for their media & activities programs. To that end, please let us know the following if you think they would also like to receive music, and we'll put them on our list.

If you don't think they would care to participate, go ahead &

Please note: only provide other people's emails if it is within your comfort zone to do so--we won't spam them, but understand why you may not be comfortable divulging that information.

Does your school have a newspaper?
 Yes
No

If yes, name of paper:


NEWSPAPER Faculty Advisor is:


Paper Advisor email (if known):

Does your School have a radio station?
Yes
No

If yes, station call letters:


RADIO STATION Faculty Advisor is:


Radio Advisor email (if known):


FOR STUDENT COUNCIL: who is the Student Council/Student Gov't/Student Activites/ASB advisor?


Student Council Advisor email (if known)


Questions/anything else we should know:

You are now current and/or signed up for the '08-'09 school year. Thank you for your interest & we look forward to working with you!