CHARLOTTE MECKLENBURG PUBLIC ACCESS CABLECAST AGREEMENT FILL OUT ALL INFORMATION PROGRAM TITLE: ____________________________________________________________________ PROGRAM PRODUCER: ______________________________________________________________ Check One: _____ New Episode / DATE TO BE CABLECAST: _____________________ _____ Repeat Episode / EXACT PROGRAM LENGTH: _____________________ Submission: ____ MiniDV ____ DVCAM ____ DVD ----- MPEG2 ____ Please use this program as a "CMPAC REWIND" following this airing. THIS TAPE CONTAINS MATERIAL OF A MATURE NATURE (yes/no): _______________________ (Programs with mature content will air between 11 PM and 6 AM.) This program contains the following material that is not of my personal creation: ___________________ _____________________________________________________________________________________ Permission from the owner(s) of this material is attached to this form. This agreement is between Charlotte Mecklenburg Public Access Corporation and the Producer named on this form, to cablecast the attached program on a Public Access Channel. I, the Producer of this program, by signing this form, do hereby indemnify and save harmless, The Charlotte Mecklenburg Public Access Corporation from any and all liability, loss, damage, expense, cause of action, suits, claims or judgments, including attorney fees arising out of, connected with, or resulting from the cable casting of the above named and attached program. I, the sole owner of this program, do hereby grant permission to the Charlotte Mecklenburg Public Access Corporation to cable cast the above named and attached program. I, by signing this form, do hereby attest that all the information entered herein is true and correct, and that the program delivered will adhere to all rules and regulations in effect at the time of signing, and that the program is my personal creation, except as noted above. ________________________________________________ ___________________________ Producer Signature Date * * * * * CMPAC USE ONLY * * * * * Notes: ______________________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________ __________________ Signature of CMPAC Staff Date |