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2. PROGRAM REQUEST FORM

   To request SEA-TV programming begin by calling the SEA-TV office at 631-702-1740.

   A staff member will be able answer questions and explain the programming parameters.
   Programming is limited to government or educational entities and related events. Please complete and submit form below.

4. Programming Request

   (Check One)

   1. Government
   2. Education
   3. Other
5. Date of Event
   Date of Event
7. Company Name
9. First Name
10. Last Name
12. Address1
13. Address2
15. City
16. State
17. Zip
19. Phone Number
20. Email
22. Length of Event:
23. Time of Event:
25. REQUESTED SERVICES
27. Venue
28. Set-up Time:
    Note: (SEA-TV Staff will need a minimum of one hour. Doors MUST be open)
29. Power Point or Video

    1. Yes
    2. No

    Must be supplied prior to event.
31. Venue Contact Information
32. Equipment Needed. Equipment Available at Venue
34. Event Schedule
36. Program and Description
    The views of the proposed program will represent either a governmental or educational entity or the elected or appointed position held by an individual in that entity.
37. SEA-TV
    SEA-TV does hereby reserve the right to accept or reject any propose filming request. Any failure interruption or delay in the requests as originally scheduled, either in whole or in part, shall not constitute a breach of the agreement if such an event results from any of the following causes: technical difficulty, emergencies, governmental restriction or any other cause beyond SEA-TV’s control.
Leave This Blank:


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

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field