Program Request for Air Form
Note: If you are under the age of 18 years old, you must provide the signature of a parent or guardian.
First Name *
Your answer
Last Name *
Your answer
Sponsor Name (If under 18 years of age)
Your answer
Telephone *
Format: 413-587-3550
Your answer
What is your email address in case we have questions? *
Your answer
Program Title *
Your answer
Program Description *
This will go in the description on our YouTube channel if you produced this content with our equipment. If content was produced independently of NCTV, description will help us find a slot to air on our channels.
Your answer
Did you utilize any NCTV equipment or facilities in the production of this piece? *
If you have used equipment or facilities in the production of your piece, NCTV will distribute the material in our online Video On Demand Library on YouTube.
Required
If you did create this video with NCTV gear, please enter KEYWORDS describing your video, separated by commas
This will help the search engine on our website find your video. Include your name in these keywords! (Ex.: Jenn Ramsay, Heavy Metal, Live Music).
Your answer
What was your role in this piece? *
Required
Is there any copyrighted music, adult content or foul language that we should be aware of? *
Including cover songs and independent artists' music videos that could be on a record label, we just don't want our youtube account to be compromised!
Your answer
Is this program a part of a series? *
Required
If this show is part of a series, what is the frequency of production?
___________________
Check your preferred times to air this program. *
We will try to accomodate but can't guarantee a timeslot unless you have a regularly produced show
Required
Agreement of Rules and Policies
I hereby agree to sponsor the program identified in this form. I understand that I am responsible for the presentation of this program or series. I agree to hold harmless Northampton Community Television, its directors and employees, and the City of Northampton from any liability, loss, claim, cost, or damage or any nature whatsoever which may arise by reason of any claim that any material distribution infringes or violates any rights of any person or organization. The program or series meets the technical and content requirement and limitations of NCTV as set forth in the NCTV Rules and Policies. I have obtained all necessary release forms and rights for the program or series content. I confirm that I am the individual or legal guardian of the individual whose name appears as the submitter of this document, and whose signed name appears below.

I understand a paper copy of this document can also be submitted at the Northampton Community Television station in lieu of electronic submission.

I also understand that the electronic submission of this form constitutes a legally binding agreement with Northampton Community Television, and that I knowingly submit and electronically sign this document.

Do you agree with the rule and policies stated above? *
(please note if you do not agree, we cannot air the program)
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