NCTE Affiliate Newsletter Award Submission Form 2017 FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. If your newsletter is a print newsletter, mail a copy of this completed form along with FOUR of THREE DIFFERENT ISSUES of your affiliate's newsletter published between May 1 of the previous year and May of the year of the award to Julie Rucker, 17 Timber Trail, Tifton, GA 31794.NOTE: You may copy long responses from WORD or another word-processing program and past them into the survey form. Question Title * 1. Please provide the following information about your affiliate's newsletter. Affiliate's Name: Affiliate Website URL: Newsletter Title: Affiliate Contact Person: Email Address: Newsletter Editor's Full Name: Newsletter Editor's Institutional Affiliation: Email Address: Newsletter Co-Editor's Full Name: Newsletter Editor's Institutional Affiliation: Email Address: Question Title * 2. Our affiliate's newsletter is A print-only publication An online-only publication A print publication that we post online Question Title * 3. If you answered "online-only" above, please provide the URL of AND access to three different issues of your newsletter online. Question Title * 4. Please describe the purpose of your affiliate's newsletter. Question Title * 5. Please list the strengths of your affiliate's newsletter. Question Title * 6. What is the approximate cost per issue of your newsletter? Question Title * 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.) Yes No Other (please specify) Question Title * 8. If you answered, "yes," please provide the name and contact information for the representative. Name: Email Address: Question Title * 9. We'd like to contact the media in your area. Please let us know which newspaper(s) should receive a press release. Name of Newspaper: URL of Newspaper's Website Name of Newspaper: URL of Newspaper's Website Name of Newspaper: URL of Newspaper's Website FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. If your newsletter is a print newsletter, mail a copy of this completed form along with FOUR copies of THREE DIFFERENT ISSUES of your affiliate's newsletter published between May 1 of the previous year and May of the year of the award to Julie Rucker, 17 Timber Trail, Tifton, GA 31794. Done