September 28, 2016 Tim Judges Application Form Email Address* Name* First Last Title*Current Employer*Number of total years in industry*Roles held (current, past), and what are your three primary responsibilities in the current role?*Industries in which applicant worked (select all that apply)*Click ctrl(win) cmd(mac) to select multiple itemsconsumertechhealthcareeducationB2Bhospitality/travel/entertainmentnonprofitcharitable givingadvertisingmediaanalyst firmotherScope of media audiences (select all that apply)*Click ctrl(win) cmd(mac) to select multiple itemstrade medialocal mediaregional medianational mediabroadcast mediaN/AScope of non-media audiences (select all that apply)*Click ctrl(win) cmd(mac) to select multiple itemsemployeescustomersinvestorsgovernment relationscharitable partnersthe general publicmedia subscribersotherother please fill inScope of content creation (select all that apply)*Click ctrl(win) cmd(mac) to select multiple itemssocial mediagraphic designarticlesblog postsinfographicsvideophotographyeventsannual reportsinvestor kitsmedia kitsprint/digital advertisingbylined articlesebookswhite paperspodcastsWhat is your experience in working on campaigns? What type of campaigns - paid only? Paid and earned? Do you feel you have enough experience to judge a campaign category?*Have you judged before? If so, most recent year of judging*Enter 0 for noWhy do you want to be a judge?*Are you or your company planning to submit award entries this year? (note, this does not disqualify you from judging, it just helps avoid conflicts of interest)*YesNoWould you be open to participating in an in-person judges event in the early spring? (if so, select the day/time that generally works best)*weekdayweekendmorningafternoonevening