Sponsor's Name________________________________________________________________

Mailing Address_________________________________________________________________

City / State / Zip_________________________________________________________________

Email______________________

Length
Hrs: Min: Sec:_______________

Format:
Live / SVHS / VHS / DVD / Mini DV

I herby warrant that the above program submitted by me does not contain any of the following
(initial each line)
______ Violation of any state or federal law relating to obscenity;
______ Material that is libelous, slanderous or other defamation of character,
            or an unlawful invasion of privacy;
______ Advertising or material which promotes a commercial product or service;
______ Material which violates copyright law;
______ Material contrary to local, state or federal laws, regulations, procedures or policy.
These warranties and representations are made by me to submit this program for cablecast on
Citizens Community Television. I further agree, to the extent allowed by law, to indemnify and
hold harmless Citizens Community Access Television, the City of Louisville, Comcast
Communications, and any of their employees, officers, Board of Directors, stockholders, agents,
volunteers, etc. from any and all claims, demands, damages or other liabilities which may be
made against or arise out of the cablecast of this program. I understand that I may be subject to
prosecution in the event this program contains any material which is unlawful or contains
obscene or other material not protected by the Constitution of the United States. I also
understand that all program material produced with Citizens Community Access Television
resources shall not be sold or used commercially. In the event of any alleged breach of the
conditions of this agreement, I agree to be obligated for all attorney fees and costs associated
with the enforcement of this agreement, in addition to charges and damages. All of the
information provided in this form is true and accurate.