NATICK PEGASUS

VIDEO SUBMISSION FORM

I have read and am familiar with and agree to abide by the policies of Natick Pegasus Inc.

I understand that the material I submit will be used for programming on Natick Pegasus’s Public, Educational and/or Government access channels.

Presentation of the following may be prohibited:

Any commercial advertising or programming

Programs, which fall below minimum requirements and technical standards for cablecast.

Programming which does not have proper clearances, releases and other assurances.

Programs identified as having material that the law prohibits Natick Pegasus from broadcasting

I understand that I am fully responsible for all programming material submitted.

I agree to obtain all necessary clearances from all organizations, individuals and groups as may be needed to videotape and/or cablecast material on access channels.

I understand that I am responsible for the production and presentations of my programs. I agree to hold harmless RCN and Comcast and Verizon, Natick Pegasus Inc. and the Town of Natick, their Directors and employees (and their successors) from any liability, loss. claim, cost or damage of any nature whatsoever which may arise by any reason of any claim that any material produced, cablecast or disseminated by me infringes the rights of any person or organization.

NAME______________________________________________________________

SIGNATURE______________________________________Date_______________

Phone Number (day)___________________________(evening)_________________

Program Title__________________________________________________________

Topic__________________________________Format_________________________

No. of Sequels__________________Frequency________________________________

If submitter is a minor: Name and signature of adult assuming responsibility

NAME_________________________________________________________________

SIGNATURE_____________________________________Date___________________

Disposition of Tape: Approved – airing_______________________________________

Denied – explanation_____________________________________