PSA/Promo Request Form

PSA/Promo Request Form
Submitting as a
NLTV Community Creator: are clients certified with Nā Leo TV to use NLTV equipment, studios, or edit bays and are Hawai‘i Island residents.
Hawaiʻi Island Presenter: are clients who submit programs completely created with outside resources. As a Hawaiʻi Island Presenter, you will need to complete a Cablecast Agreement form found in the Forms and Documents tab at naleo.tv.
Date Submitted

MonthDayYear
PSA Title
PSA Length - Must be EXACTLY 1 minute or 2 minutes in length!
Description of PSA
TIME SENSITIVE: PSA/Promo must be aired within a specific time frame. If yes, add dates below. Start Date Date End Date Date
Does this submission adhere to Nā Leo TV's PSA/Promo Technical Requirements?
Name of Producer/Presenter

First NameLast Name
Signature
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Name of Representing Organization (if applicable)
Today's Date

MonthDayYear
For record purposes
If you are NOT the Copyright Holder, attach a permission letter with a signature and contact information below. Please inform NLTV Staff when your contact information has changed. For more information regarding submission requirements or to review a copy of the Public Access Policies & Procedures click here or visit our website naleo.tv and look under resources.
Attach a File (not required)

Cancelof
Should be Empty: