Special/One Time Program ProposalPlease complete the form below to the best of your ability. The information provided will be reviewed by the Program Committee to evaluate your proposal, and see that it aligns with our mission and standards. You will be contacted by our Programming Director directly regarding this process. Thank you for your interest in participating in community media!Producer InformationYour Name First Last Proposed Program TitleProducer Name First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Host Host is same as producerHost Name* First Last Host Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Host Email* Host Phone*Host's Bio, Resume, or Other Relevant Experience Information*Organization DetailsIs this program representing or on behalf of a business/organization? Yes NoOrganization/Business Model* For Profit Not for Profit Organization/Business Name*Organization/Business Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Organization/Business Phone*Organization/Business Website* Organization's MissionSubject/Topic What will the program be about?Have you ever hosted, produced or been a guest on a TV or radio show? Yes NoList when, where, and the format you hostedIf you plan to have a guest(s) on this program, please list them belowExplain how you plan to present information on your programTypically, producers use guests, video clips, still photographs and other visual aids in the studio. BCTV has limited resources to do off-site taping, and this may incur additional production costs.To defray costs associated with producing your program there is a suggested donation of $50. BCTV is a 501(c) nonprofit organization. Recognizing BCTV’s status as a non-profit corporation, there will be no obscene, indecent, libelous or slanderous material, no inflammatory material, no lottery is involved and no lottery information will be cablecast; there will be no religious proselytizing, no commercial advertising and no political campaigning.BCTV is a nonprofit organization that relies on donations, and sponsors. There is a suggested donation of $50 for each Special/One Time. Rates are established by the Board of Directors and are subject to change. I have read all of the above and agree. I do not agree.Final AgreementName* First Last Date MM slash DD slash YYYY Verify and Submit
