Contact

George Fairfield
The Jersey Access Group
(732) 562-2305
gfairfield@piscatawaynj.org

14th Annual JAG Video Awards Registration

Enter the JAG Video Awards

* Required information

Personal Information

* First Name:
* Last Name:
* Email Address:
* Confirm Email Address:
* Address 1:
* City:
* State:
* ZIP Code:
* Phone:
Cell Phone:

Fee

Type	Fee
Member 1 submission	No Charge
Member 2 submissions	$25.00
Member 3 submissions	$50.00
Member 4 submissions	$75.00
Member 5 submissions	$100.00
Non-member 1 submission	$50.00
Non-member 2 submissions	$100.00
Non-member 3 submissions	$150.00
Non-member 4 submissions	$200.00
Non-member 5 submissions	$250.00

Station/Organization Information

* Station/Organization
* Address 1:
* City:
* State:
* ZIP Code:
* Phone:

Requirements of All Submissions

All registration forms must be received by 8:00pm EDT on February 28, 2022. All payments or purchases orders must be received by May 1, 2022 or your will be disqualified.

Payment

Payment Method

Pay By Check
Please make check payable to:
Jersey Access Group
P. O. Box 164
Metuchen, NJ 08840

Payment Summary

*

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