D
Part 2
General Information
1.
Title of Program: _______________________________________________________
1A.
Brief Description of Program (You may use a separate sheet of paper if necessary):
______________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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__________________________________________________________
________________________________________________________________________________
2.
Is your program a:
Series (more than one program)
(Please check one)
Program (one program)
Filler (program less than 15 minutes long)
3.
Number of episodes to be aired:
________
Length of each episode:
________ hour(s), ________ minute(s), ________ second(s)
Number of episodes already completed:
________ (Ready to air)
4.
Producer: __________________________________________________________
Station
Independent Producer
Foreign
5.
Producer Address: Street: _________________________________________________________________________________
City:
____________________ State: _________
Zip:
____________________ Country (if not USA): __________
6.
Producer Phone Number:
Country code (if not US/Canada) required
Phone: _____________________________________________________________________________________________________
7.
Producer E-mail and/or Web Address: _________________________________________________________________________________________________
8.
Local Contact's name: (Required if different from above) __________________________________________________________
9.
Local Contact Address:
Street: ______________________________________________________________________________________________________
City:
____________________ State: ___
Zip:
____________________ Country (if not USA): __________
10. Local Contact Phone Number: ______________________________________________________
Country code (if not US/Canada) required
Phone: _________________________________________
