Cablecast Request Form

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Ludlow Community Television IMPORT PROGRAM CABLECAST REQUEST Program Title: ________________________________________________________________ Channel time request: _________________________________________________________ Note: All requests must be received by the staff one week prior to the requested cablecast date. Producers are not guaranteed the requested time slot. Regularly produced series programs will hold a weekly time slot.

Please provide a brief description of program for publicity purposes: _____________________________________________________________________________ All programs must be properly labeled on the tape spine or DVD cover with the following information: 1. Total run time 2. Name of program producer with phone number 3. Date program was produced *** Programs submitted without this information WILL NOT be shown on LCTV. I, the undersigned, warrant and represent to LCTV that the above program meets the criteria for cable access programming defined in the LCTV Policies and Procedures. The above material submitted by me contains none of the following: 1. 2. 3. 4. 5.

Any material which contains commercial advertising. Direct or indirect solicitation of goods, services, or funds. Promotion of lottery or illegal gaming. Any material that is obscene or indecent. Promotion of illegal activities.

These warranties and representations are made by me in order that this program be cablecast on LCTV access channels. I agree further to indemnify and hold harmless LCTV, the Town of Ludlow, and any of their employees or officers from any and all claims, demands, damages, or other liabilities which may be made against or arise out of the cablecasting of the program submitted by me whether or not the program has been reviewed by LCTV prior to cablecast. I further agree to pay LCTV or the Town of Ludlow any and all legal fees and expenses incurred by this program in connection with any legal proceedings concerning cablecast, as such legal fees and expenses arise.

Program Producer: _____________________________ Phone: __________________ Address: _______________________________________________________________ Producer Signature: ________________________________ Date: ________________

Received by: ________________________________ LCTV Manager

________________________ Date