1. PRODUCER/PROVIDER
(Must be West Hartford Resident)
| Name________________________ |
Phone______________ |
Date
Submitted__________ |
2. PROGRAM TITLE
____________________________________________________
| 3.
STUDIO _____ |
REMOTE____ |
OTHER
(please specify) ________________ |
4. DEADLINE FOR
AIRING IF APPLICABLE _________________________________
5. PROGRAM TOPIC/DESCRIPTION
(be as specific as possible; this information will be used for publicity)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6. NAME OF PROGRAM
HOST__________________________________________
7. HOST'S TITLE
(if applicable)____________________________________________
8. GUESTS (Total
Number) ________
Use this space to list names and titles of all guests; be sure spelling
is correct-once "supered" it cannot be corrected.
| Name
|
Title |
| 1.
_________________________________ |
_________________________________ |
| 2.
_________________________________ |
_________________________________ |
| 3.
_________________________________ |
_________________________________ |
9. PROGRAM LENGTH:
15 minutes___
|
28 minutes___
|
Other________
|
10. WILL YOU BE
USING: (check all that apply)
SLIDES?___
|
PHOTOGRAPHS?___
|
ROLL-INS?____
|
CHARTS/GRAPHS?____
|
OTHER
PROPS? ____ |
|
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