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 AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 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 Δ