Addiction Studies Program click for image information
 

Journalists
Register
(Please print and fill out.)

Attendance at the Addiction Studies Program for Journalists workshops is limited. Please register early. Hotel lodgings and meals (continental breakfast and lunch on Days 1 and 2; dinner on Day 1) are included in the conference fee.

Full scholarships are available for journalists who otherwise cannot afford to attend. To apply, fill out both the Application Form and the Scholarship Form.

The Addiction Studies Program is co-sponsored by Wake Forest University School of Medicine and National Families in Action. National Families in Action handles all logistics for the workshop. 



Application Form
Name

__________________________________________________________________

Position
__________________________________________________________________

Name of Medium
__________________________________________________________________

Address
__________________________________________________________________

City
__________________________________________________________________

State
__________________________________________________________________

Zip
__________________________________________________________________

Phone (Office)
__________________________________________________________________

Fax
__________________________________________________________________

Phone (Home)
__________________________________________________________________

Phone (Cell)
__________________________________________________________________

Pager
__________________________________________________________________

Email
__________________________________________________________________

Kind of news you cover
__________________________________________________________________

__________________________________________________________________

Dietary restrictions, if any
__________________________________________________________________

Scholarship Application Form
___ Please accept my application for a scholarship to cover the cost of the conference and reimbursement of my transportation expenses after the conference.

I have enclosed:

___ My resume

___ A list of recent stories I have written related to alcohol, tobacco, or drug use/abuse/addiction or similar social issues and where they have been published

___ A brief paragraph describing why I want to attend this workshop

Send via email to srusche@nationalfamilies.org
Or
Mail to:
Addiction Studies Program for Journalists
National Families in Action
P.O. Box 133136
Atlanta, GA 30333-3136
For more information call 404-248-9676.

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