Registration form Media Literacy Certificate Course July 10 – 16, 2011

Please copy and paste this form into a Word or text document, fill it out, and send with your check by June 25, 2010.

Advanced Certificate in Media Literacy

Registration Form

Name:

Address:

City:

State:                             Zip:

Home phone:

Cell phone:

Email:

___ I am enclosing my check ($230.00) for the Advanced Certificate in Media Literacy. I understand that I am responsible for my travel, meals (except continental breakfasts, snacks on class days, and one dinner), medical care and that this stipend covers text books (except for the National Directory for Catechesis), materials, etc.

Signature: _____________________________________ Date: _________________

Please make the check out to: Daughters of St. Paul/Media Literacy Course

Please send to:

Registrar

Pauline Center for Media Studies

3908 Sepulveda Blvd

Culver City, CA 90230

For any questions, please email Sr. Hosea at PCMS@paulinemedia.com.

Things you will need for the course:

-  laptop computer

- light sweater (room will be air conditioned)

- digital camera or video camera (not required)

- walking shoes (our of Sony lasts two hours)

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