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2. Thank your for your interest in providing information on CountyNET. Please fill out the below fields with your contact information in case there are any questions regarding content. Fields with an asterisk (*) are required.
4. First Name*
5. Last Name*
7. Email Address*
8. Phone Number*
9. Preferred Contact Method*
   -- Select One --EmailPhoneEither one
11. Organization/Department you are representing*
13. What type of message are you submitting for CountyNET?
    -- Select One --Public Service AnnouncementDate Specific Event for PromotionJob RecruitmentPublic Meeting NoticeInformation about County Program or ServiceOther
15. If you selected "other," what type of message are you requesting to be aired on CountyNET?
17. Example of Slide 1
    
18. Example of Slide 2
    
21. Message Title*
23. Message Content - Slide 1*
    All slides have a maximum character limit of 250 including spaces for the main content area.
25. Message Content - Slide 2
27. Message Content - Slide 3
29. Message Content - Slide 4
31. Please fill out the below fields with the contact information to be included in the message that will be seen on CountyNET. Make sure to include at least one valid phone number or web link so viewers can get more information if necessary.
33. Contact Phone Number for the Public
34. Email Address or Website for the Public
36. Date range for messages to be played; please submit your request at least two days before the first date you want it to air on CountyNET.*
    Date range for messages to be played; please submit your request at least two days before the first date you want it to air on CountyNET. Start Date

    —

    Date range for messages to be played; please submit your request at least two days before the first date you want it to air on CountyNET. End Date
38. Questions, Comments, and Special Instructions
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field