TV Middletown

Public Service Announcement (PSA) and Calendar of Community Events Form

We encourage you to submit your announcements as often as you like, but we must ask youto follow the format outlined on this form. If you have any questions, please call (513)727-3000, and we will do our best to provide you with the information you need. Thank you.

All forms should be submitted via FAX (513/727-4760) or by mail to TVMiddletown Calendar of Community Events, 1131 Central Avenue, Middletown, Ohio 45044. You can also submit the information requested in this form via email. Note: Please print clearly and completely fill out this form.Incomplete forms or information will not be considered. All PSA requests related to events must bereleased three weeks prior to air time.

  1. Date(s) & year of event  _________________________________________________
  2. Name of event  ________________________________________________________
  3. Event is held at (site name)  ______________________________________________
  4. Street address and city __________________________________________________
  5. Describe the event in 15 words or less  _____________________________________
       ___________________________________________________________________
       ___________________________________________________________________
  6. Days/hours (opening and closing) of event  __________________________________
       ___________________________________________________________________
  7. Admission fee charged? _____ Yes _____ No
  8. Name, address, city, and zip code of contact person for event    ___________________
       ___________________________________________________________________
       ___________________________________________________________________
  9. Phone number to be published for more information about this event  ______________
  10. . Last year's attendance for event  __________________________________________
  11. . Coordinating organization for event _______________________________________
  12. . Name of person completing this form ______________________________________
  13. . Your affiliation with event ______________________________________________
  14. . Form submission date __________________________________________________

TV Middletown reserves the right to exercise its discretion in listing or rejecting any event, and to edit for editorial and graphic impact. Air time will average between fiveand ten days depending on the channel's programming schedule.

I have been authorized to display this message on TV Middletown and on Time-Warner Cable TV and agree to indemnify and hold harmless Time-Warner Cable and TV Middletown, officers, agents and employees from liability, legal fees and other expenses incurred as a result of cablecasting this public service message.

Signature_______________________________________________________________   Date_______________________________________________