Muskego Public Access Group (Muskego Access Channel 7 -- MACH7)
VIDEOTAPE SUBMISSION FORM
(ONE FORM PER TAPE or SERIES)
Date submitted:________________________ Submitted to:__________________________
Project Title:______________________________________________ (MPAG Production only)
Program Title:_____________________________________________ (25 characters or less, on screen)
Length:____________________(Exact Min. & Sec. of program show)
Lead Time: _____________________ (time from start of tape to start of show, if not 2 minutes,)
Funding Source:____________________________________________________________
Subject category: (Please check one, plus EVENT if applicable)
_____ Arts&Entertainment ______ Community Service Info______ Inspirational/Spiritual
_____ Health & Well-being ______ Issue-Oriented ______ Sports ______ EVENT*
If Event category, for event programming: (Please check one)
______ Community-Wide Event ______ School District Event ______ Recreation/Park Program
______ City of Muskego Meeting ______ Other Public Meeting ______ Other ___________________________________________
For event or other programming, do you wish to have MPAG titles or credits added to the program? ____ Yes ____ No
If titles/credits are desired, should they be applied to the original tape? _____ Yes ______ No
Program Origin: ____ MPAG Production ____ Muskego Resident ____ Wisconsin Resident/Organization ____ Outstate (Please check one)
Tape format: ____ VHS ____ SVHS ____ Umatic _____ Other:________________ (Please check one) If not T120 length: ____T160 ____ Other
Tape Speed: Normal-standard play (SP) ____ EP/SLP ____ LP ____ Audio: ____ Mono ____ Stereo ____ HIFI ____ Dolby B (please check)
EARLIEST AIR DATE (request):________________
LATEST AIR DATE (for return, if not permanent MPAG program) :___________________
Is this tape to be returned to the presenter after last air date: _____ Yes _____ No (I donate this tape to MPAG)
If the tape is to be donated to MPAG for permanent use, do you wish to have a copy made of this program to keep? ____ Yes ____ No
Brief Program Description:
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Additional Production/Airing instructions:______________________________________________________________________
DOES THIS PROGRAM CONTAIN ADULT SUBJECT MATTER THAT YOU WOULD PREFER IT BEING SHOWN AFTER 10:00 PM? ____ Yes ____ No
__________________________________________________________________________
PUBLIC DISCLOSURE INFORMATION (required for public inquiry and referral)
Producer / Presenter:_________________________________________________________
Organization:_______________________________________________________________
Mailing Address: ____________________________________________________________
City: ____________________State: __________ Zip:___________
Day Phone Number_____________________Evening Phone Number__________________
Copyright owner: ____________________________________________________________
Phone Number: _________________________
Every program that is submitted to MPAG: Muskego Public Access Group must have a Local Presenter/Provider. One who resides in Muskego, or is a MPAG member.
(Revised 23 November 1996)