Outta Your Backpack Media Workshop! Nov. 24th & 25th, 2007 - 10AM - 5PM At the Youth Media Arts Center/Infoshop 1926 4th Street #7B Flagstaff, AZ Outta Your Back Pack Media Project Workshop Application Name: Age: Ethnicity: Gender: Address: City: State: Zip Code: Email: Home Phone Number (Daytime):   (Evening): Parent/Guardian’s Name: (Phone Number if Different): Emergency Contact: Phone Number: Relation to you: Please answer the following questions. Use additional space if necessary. 1). What type of media or technology experience have you had before? What kind of production equipment (digital camera, video camera, and editing computer, etc.) do you have access to? 2). What are your strongest interests in film? (examples: screenwriting, cinematography, directing, editing) 3). How do you best hope to benefit from this workshop? 4. How do you feel the media impacts you and your community? 5. If you could make a 3-5 minute video, what would be some of things you would share? 6. Are there special needs that you have for the training that we should know about? (e.g. differently-abled access, Dietary etc.)? Download, fill out and email the application by WEDNESDAY, NOVEMBER 14th, 2007. This workshop is limited to 14 participants.  If you need any special accommodations with this deadline or are planning to send the application by mail, please e-mail IAM so that we can expect your application or address your needs immediately.  Also please post and forward this application so that as many youth get the chance to apply. Please complete the application and return no later than WEDNESDAY, NOVEMBER 14th, 2007 to info(at)indigenousaction.org or the address below: Please call (928) 380-2629 if you are mailing your application. Indigenous Action Media P.O. Box 1492 Flagstaff, AZ 86002