Application for Public Access Cable Channel Playback

Application for Public Access Cable Channel Playback
For Pre-produced Tapes and Community Video Center Produced Tapes

Please fill out, print, sign, and send to the Communications Office.

Attention: Renee Dallman, P.O. Box 8784, Williamsburg, VA 23187-8784

Name/Group:

Address:

Phone Home:

Phone Business:

Title of Program:

Program length:

Subject Matter:

Playback times - Mark your first, second, and third choices with a #1, #2, #3.

12 a.m.
1 a.m.
2 a.m.
3 a.m.
4 a.m.
5 a.m.

6 a.m.
7 a.m.
8 a.m.
9 a.m.
10 a.m.
11 a.m.

6 p.m.
7 p.m.
8 p.m.
9 p.m.
10 p.m.
11 p.m.

Broadcast request:

I request my program be aired on Public Access Channel. I further understand
that my program will be aired between two and three times a day for two weeks. Program time and date playback requests are dependent upon the number of programs submitted, programs already scheduled for air, and the program length.


Signature of Applicant		Date

_______CVC Produced _______ Pre-Produced