First Name: M.I.: Last Name:
Address:
City : State: Zip:
Phone Number: Home: Work:
Email: Website:
I represent an organization
Organization Represented:
Organization Address:
Organization's Email: Website:
Single Program Title
Series Program Title
Segment # of programs in series.
Series Title
Check One Box Only: Locally Produced Program Imported Program with some local production Describe: Imported Program with no local production If Imported: Annual User #: or Cablecast Fee:
Tape stock owned by: Producer MCAT (MCAT Tape #: )
Brief Program Description:
Is viewer discretion recommended? (Does the program contain material which may be inappropriate for children or offensive to sensitive viewers?) Yes No If yes, please explain:
If Dated Material, Stop Date:
Credits:____________________________________ Cablecast Schedule:___________________________ Disclaimers:_________________________________
Program has a clear ending with any subsequent video/audio erased.
I understand that MCAT may use portions of this program for non-commercial, promotional purposes.
I understand that this program shall be made available for viewing at the studio seven days prior to and seven days after cablecast.
I understand that I must provide this program at least 24 hours in advance of its cablecast time.
I, the undersigned, warrant and represent to Missoula Community Access Television that the above program submitted by me contains none of the following:
any advertising or material that promotes any commercial product or service or lottery
any unlawful use of copyrighted material
any material that is libelous, slanderous or defamatory of character; or material that is an unlawful invasion of privacy
any material that violates state or federal law relating to obscenity
any solicitation or appeal for funds (Programs may describe fundraising events or projects, but may not contain a repetitive emphasis on financial need or direct requestsfor funding)
any material that violates local, state or federal laws.
These warranties and representations are made by me in order that this program be cablecast on MCAT. I agree, further, to the extent allowed by law, to indemnify and save harmless MCAT, the City of Missoula, AT&T Broadband, Fibervision, Inc., and any of their employees, officers, Board of Directors, stockholders, etc., from any and all claims, demands, damages or other liabilities which may be made against me or arise out of the cablecast of the program submitted by me whether or not the program has been reviewed by MCAT prior to cablecast. I am aware that Section 639 of the Federal Cable Communications Policy Act of 1984 provides that: "Whomever transmits over any cable system any matter which is obscene or otherwise unprotected by the Constitution of the United States shall be fined not more than $10,000 or imprisoned not more than 2 years, or both."
I also warrant that I have read and understand the Missoula Community Access Television Handbook and this Program Contract.
I am under 18, my adult co-signer is:
Date:
