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2. Contra Costa Television (CCTV) is a government access station. If you work for, or represent a government agency please complete the following information.
4. 
   
6. Contact Information
8. Name:*
10. Government Agency:*
12. Address:
14. City:
16. State:
17. Zip:
19. Phone Number:*
21. Email Address:*
23. Program Information
25. Program Title:*
27. Program Description
    (150 character limit):*
29. Program Length:*
31. Producer:*
33. Expiration Date:*
35. 
    
37. Applicant hereby applies to CCTV for use of the Governmental/ Educational channel, on the following terms and conditions:
39. 1. Applicant is submitting with this application a prerecorded program which Applicant desires to have cablecast.
41. 
    
43. 2. Applicant represents that (s)he has read CCTV Operating Policy and Procedures, and hereby agrees to abide by the terms and conditions contained therein.
45. 
    
47. 3. Applicant represents that (s)he is aware of the restrictions on "Program Content" set forth in Section D of the CCTV Operating Policy and Procedures and represents that the program does not violate any of those restrictions.
49. 
    
51. 4. Applicant represents that (s)he has made all appropriate arrangements with, and has obtained, without limitation, all necessary licenses and/or clearances from broadcast stations, sponsors, music licensing organizations, performers' representatives, copyright holders and any and all other persons (natural or otherwise) as are necessary to lawfully transmit program material over CCTV's Channel.
53. 
    
55. 5. Applicant hereby agrees to hold CCTV harmless from any and all loss, liability, damage or other injury (including the reasonable costs of litigation or the defense of any claim) CCTV may suffer as a result of claims, demands, costs or judgment against CCTV arising out of or in connection with Applicant's use of CCTV's channel, including, but not limited to, the failure to comply with any applicable local, state or federal laws, rules, regulations or other requirements; and claim for libel, slander or the invasion of privacy; any claim of infringement of common law or statutory copyright; any claim for the unauthorized use of any trademark, trade name or service mark; any claim for breach of contractual or other obligations owing to third parties by CCTV and for any other claim.
57. 
    
59. 6. Applicant hereby waives any claim or right against CCTV resulting from the loss, destruction or damage to any videotape submitted by Applicant or resulting from the failure or refusal to cablecast the videotape or cablecast it at the scheduled time. Further, Applicant hereby releases CCTV from all such claims. Applicant hereby represents that the videotape submitted by him has no economic value other than the value assigned the videotape on which any information is recorded.
61. 
    
63. 7. Further, Applicant understands that its NAME and MAILING ADDRESS WILL BE MAINTAINED at CCTV's offices and may be made available to members of the public, including governmental agencies, upon reasonable request therefore. Applicant hereby consents to the release by CCTV of Applicant's name and mailing address to any members of the public, including any governmental agency.
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65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

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