Program Submission Form

Date:_______________________

Name:________________________________ Phone:___________________________

Address:________________________________________________________________________________________________________________________________________________________________________________________________________________________

Organization (If Applicable):_______________________________________________________________________________________________________________________________________________________________________________________________________

Organization Address:____________________________________________________________________________________________________________________________________________________________________________________________________________

Program Title:___________________________________________________________________________________________________________________________________________________________________________________________________________________

Program Description:_____________________________________________________________________________________________________________________________________________________________________________________________________________

Single Program______ Series: Weekly______ Series: Monthly______

All Programs submitted must be labeled with the title of program and program # (if series) and the exact running time (this is required)

Does this program contain materials which may be inappropriate for young viewers and therefore requires an assigned time slot after 10:00pm? ___________________

Program Format: DVD________ MPG2________Other_______________________

Does this program contain time sensitive material and/or tie in with a specific public event?

All Applicants must read the following before signing:

I acknowledge that the submitted program contains material that may be considered offensive, controversial, and/or inappropriate for younger audiences and therefore agree to an assigned cablecast time slot after 10:00pm. I also agree to a “Viewer Discretion Advised” warning on all scheduled listings as well CCTV promotional material.

If the preceding statement applies, please initial here:_________

I have read, am familiar with, and agree to abide by the policies and regulations regarding programs aired on CCTV’s Public, Educational, and Government Channels.

1. I am familiar with the nature of the program material and take full responsibility for its content.

2. I understand that the following material is prohibited for presentation on the Public Access Channel for Concord and Carlisle:

  • Any commercial advertising.
  • Any material which constitutes libel, slander, invasion of privacy or public rights, or use of trademark or copyright which may violate local, state or federal law.
  • Any material concerning lottery information, gift enterprise, or similar scheme.

3. I understand that I am responsible and agree to hold harmless the cable provider, CCTV, its staff and board of directors from any liability, loss, claim, cost or damage of any nature whatsoever which may arise from cablecasting the above mentioned program.

4. I understand that it is CCTV’s policy to program any material which may be considered offensive, controversial and/or inappropriate for younger audiences after 10:00pm and have indicated above if this program contains such material.

Producers Signature:________________________________________________________________________________________________________

Date:________________________________