program proposal

The Public Access TV Corporation

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

Program Proposal

This form must be submitted (Fax or drop off at PATC) one (1) month prior to your shooting date.

Name (Producer):_______________________________

Phone:_________________

Address:_______________________________________

Organization:_______________________

E-mail:_______________________

Fax:_________________________

Village:____________________________________________

Membership: Yes No

Policies & Procedures Access Manual: Yes No

Statement of Compliance: Yes No

Description of Program: (Briefly describe program, intended audience, facilities and equipment)

______________________________________________________________________________________________

PATC Courses: (Check which courses you are interested in taking or the date that you completed the course)

Studio____ Porta-Pak____ Van____ Editing____ Directing____

Circle the format needed:

Studio Remote Van Combination

Equipment & Reservation Forms Filled: Yes No

Cablecast Date form filled:_________________________ _________________________

Signature:____________________

*Printed from PATC website*