Form Center

2. 
4. Attach proof of residency.
   Driver's license, state issued I.D., or utility bill with current address are accepted.
6. Series Title (max. 25 characters)
7. Date
   Date
9. Series Descriptions (max. 200 characters)
11. Number of Programs in Series
12. Frequency of Programs
14. Topic of Series
15. Program Length
17. BCTV Production

    1. Yes
    2. No
18. Other
22. Adult Content (check all that apply)

    1. Language/Profanity
    2. Nudity
    3. Sexual Content

    1. Depicts Violence
    2. Other
24. Is this program suitable for viewing by children?

    1. Yes
    2. No
28. Name of Program Creator
30. Program Creator Email Address
32. Program Creator Phone Number
36. Sponsor Information
    This section is to be completed if you are not the creator of the program, but are sponsoring the playback of the program on BCTV.
38. Name of Sponsor
40. Street Address
42. City
43. State
44. Zip Code
46. Sponsor Email Address
48. Sponsor Phone Number
52. Click to read Operational Rules
    OPERATIONAL USE POLICIES
54. I certify that I have read Burnsville Community Television’s OPERATIONAL USE POLICIES, and I understand that I am responsible for the content of the program that I produced for playback on the access channel(s). I understand that if I am sponsoring a series of programs as a resident of Burnsville not made at Burnsville Community Television and/or not produced by me, that I assume the same responsibilities as a producer for the content of the program according to the OPERATIONAL USE POLICIES. I affirm that:
    • No lottery information will be cablecast • No obscene/indecent material or language shall be cablecast, nor programs that promote illegal acts. • The program contains no advertising, soliciting for funds, or revenue generating activity. • All clearances have been obtained from performers/talent, stations, sponsors, copyright holders, etc. • If a live cablecast, I have taken reasonable measures to ensure compliance with this statement.
56. I assume full responsibility for any disputes arising from unauthorized use of copyrighted material. As producer or sponsor, I am solely responsible for the content of this program series.
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field