FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. If your journal is a print journal, mail a copy of this completed form along with FOUR copies of ONE issue of your affiliate's journal published between May 1 of the previous year and May of the year of the award to Lawrence Butti, 5856 214th Street, Bayside, NY 11365-1833.

NOTE: You may copy long responses from WORD or another word-processing program and paste them into the survey form.

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* 1. Please provide the following information about your affiliate's journal.

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* 2. Our affiliate's journal is

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* 3. If you answered "online only" above, please provide the URL of AND access to your journal online.

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* 4. Please describe the purpose of your affiliate's journal.

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* 5. Please list the strengths of your affiliate's journal.

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* 6. What is the approximate cost per issue of your journal?

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* 7. If recognized, would your affiliate be responsible for having a representative on hand for the awards presentation at the Affiliate Breakfast during the NCTE Annual Convention? (NOTE: The representative is expected to purchase a breakfast ticket with preregistration.)

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* 8. If you answered, "yes," please provide the name and contact information for the representative.

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* 9. We'd like to contact the media in your area. Please let us know which newspaper(s) should receive a press release.

FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. If your journal is a print journal, mail a copy of this completed form along with FOUR copies of ONE issue of your affiliate's journal published between May 1 of the previous year and May of the year of the award to Lawrence Butti, 5856 214th Street, Bayside, NY 11364-1833.

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