MMCTV Cablecast Submission Form

Name *

Address *

Organization (if applicable)

Phone Number *

What is the Town, County and State where the program was produced? *

Program Show/Title *

Please provide a short description of your program as you would like it to appear for promotional and programming purposes. *

Is it a series? *

Yes

No

For Series, initial to indicate that this form is to serve in perpetuity for your series.