Curry County Voices Program Submission Form
This form must accompany all program submissions to Curry County Voices.
Email address *
Program Information
Date Submitted *
MM
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YYYY
Date Recorded *
MM
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DD
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YYYY
Have you previously submitted this content to Voices? *
Is this part of a regular Voices series? *
Series or Show Title. *
Your answer
Episode Title
Your answer
Episode Number
Your answer
Brief TV Guide Style Description of Content *
Your answer
Keywords/Categories (Please list 3) *
Your answer
Is this content time sensitive? *
Earliest Play Date
MM
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DD
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YYYY
Latest Play Date
MM
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DD
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YYYY
Program Usage Information
May we post your locally produced program on-line at archive.org? *
May we post your locally produced program on the Curry County Voices website and YouTube? *
Which Creative Commons options did you choose? (see www.creativecommons.org for details) *
Required
Would you prefer to waive all rights and place your content in the Public Domain? *
Program Content Information
Does this Program Contain "ADULT" or Controversial Material? If yes, Please complete the next question. *
Description of Adult Content
Your answer
Was VOICES Field Equipment Used to Produce this Program? *
Was VOICES Editing Equipment Used to Produce this Program? *
Was this program produced in Curry County? *
Do you own the copyright to this program? If No, please complete the next question. *
Copyright holders contact info. You do not need to complete this question if you own the copyright.
Your answer
Do you have permission to Cablecast this program? Note: This includes all copyright, talent and location releases. Documentation of these releases is the sole responsibility of the producer submitting this form. You will be contacted by Voices in the event of a content dispute. *
Your Contact Information
Name *
Your answer
Phone Number *
Your answer
PLEASE READ THE FULL TEXT BELOW BEFORE SUBMITTING.
By clicking submit on this form, I certify the following to be accurate: I am a legal adult and a resident of Curry County, Oregon. I understand Curry County Voices Policy and that I bear complete responsibility for the content of the program I am submitting for cablecast to the viewers of Charter Cable. I attest the information on this form is valid, correct and complete and that I have read the reverse side of this form.
A copy of your responses will be emailed to the address you provided.
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