The Public Access TV Corporation

1111 Marcus Avenue, LL27, Lake Success, NY 11042. Tel: (516) 629-3710 Fax: (516) 629-3704

Facilities Request Form:
Fax (629-3704) or drop off at PATC

Date: ______ / ______ / ______
Name:____________________________________ Phone:_______________
Name of Program/Series:________________________________________________
Title/Episode:_________________________________________________________

Studio Facility
Request dates: (1)_____ Day _____ / _____ / _____ Time: ___________
(2)_____ Day _____ / _____ / _____ Time: ___________ Additional/Alternate
(3)_____ Day _____ / _____ / _____ Time: ___________ Additional/Alternate
Number of request:____________
If applicable, please list the names of the Certified Crew who will be working with you
Name:__________________________________________________ Phone:_________________
Name:__________________________________________________ Phone:_________________
Name:__________________________________________________ Phone:_________________
Reservations will be taken as early as 2 months prior to requested date and no later than 2 weeks prior.
Reservations are booked on a first come-first served basis. PATC programs take preference.

** Facilities can be reserved for 4 hours maximum in one day.**

Editing Facility
Facility needed: ____________ SVHS ____________ Control Room
* Note: Producers may book only one facility at a time. If you need to book both, simultaneously, please see Executive Director.
Request dates: (1)_____ Day _____ / _____ / _____ Time: ___________
(2)_____ Day _____ / _____ / _____ Time: ___________
(3)_____ Day _____ / _____ / _____ Time: ___________
If applicable, please list the names of the Certified Crew who will be working with you:
Name: ___________________________________________________________
 
*** Description of program: number of guests - names of crew - props, sets, equipment needed other than basic facility operation (use back for listing info.)
 

*Call office with any cancellations or changes immediately.*

I agree to show up on the day requested (or else cancel a sufficient time beforehand) and assume full responsibility for damage or loss of the equipment while it is in my possession. I understand that negligent handling of this equipment may result in the forfeiture of the right to use it in the future. All crew has been PATC certified (no unauthorized crew) and the program that this equipment and/or facility is being used for is a program that will be aired on PATC.
 

Producer's Signature: ______________________ Date: _____ / _____ / _____

Producer is responsible for confirmation and the pick-up and drop off of tapes.

*Printed from PATC website*