ALL ENTRY FORMS MUST BE TYPED.
FILL IN THE REQUESTED INFORMATION BELOW, THEN PRINT OUT THE COMPLETED FORM.
THE PRINTED FORM MUST BE SIGNED BY THE NEWS DIRECTOR. THE PRINTED FORM MAY ALSO BE PHOTOCOPIED AND REDUCED TO FIT AS A LABEL ON ENTRY DVDs AND CDs.

CATEGORY NUMBER:
DIVISION (A or B):
DATE OF BROADCAST:
ENTRY TITLE:
LENGTH:
STATION CALL LETTERS (INCLUDING AM, FM, TV):
CONTACT NAME:
TELEPHONE:
E-MAIL:

FOR ENTRY, LIST ALL OF THE AWARD WINNERS ON THIS FORM.
THE NAMED INDIVIDUALS MAY BE RECOGNIZED AT THE GOLDEN MIKE AWARDS DINNER.
NOTE: MORE THAN EIGHT NAMES WILL BE RECOGNIZED AS "STATION STAFF" DURING THE AWARDS CEREMONY.

I ATTEST THAT NONE OF THE CONTRIBUTORS FOR THE "BEST NEWSCAST" CATEGORIES WERE SPECIFICALLY EMPLOYED FOR THE "DESIGNATED NEWS WEEK". I AUTHORIZE THE RTNA TO USE CLIPS OF ENTRIES FOR THE AWARDS SHOW AND THE AWARDS SHOW TELECAST.

NEWS DIRECTOR'S
SIGNATURE REQUIRED:__________________________________________