REGISTRATION ITJA Please fill out the form fully and accurately. ITJA Entry Form First Name Last Name Address Address Street Address Street Address Apt, Suite, etc. Apt, Suite, etc. City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Cell Phone Email Confirm Email College/University Major Class Rank Freshman Sophomore Junior Senior Graduate Student Each student must have a faculty member verify that she/he/they is a current part-time or full-time student at their institution and are willing to serve as a reference by emailing the ITJA Coordinator. Faculty First Name Faculty Last Name Faculty Email Address Valid Email Confirm Faculty Email Address Confirm Email I agree to attend ALL of the Institute's daily workshops and to attend and review festival main stage productions from among those designated by the ITJA coordinator. I understand that failure to do so will lead to my elimination from the Institute for Theatre Advocacy. Initial to Acknowledge * Submit If you are human, leave this field blank.