Outta Your Backpack Media Project Workshop! "Basic Production Skills" Thursday Nov. 8th, 2007- 4PM - 7PM At the Youth Media Arts Center/Infoshop 1926 4th St. #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? Please complete the application and return NO LATER than FRIDAY, NOVEMBER 2th, 2007 to info@indigenousaction.org. Please call (928) 380-2629 if you have any questions. Klee Benally: info@indigenousaction.org www.indigenousaction.org