PSA Submissions only

Name*

PrefixFirst NameLast Name

Phone Number*

Area CodePhone Number

Alternate Phone

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email:*

Website:

Organization (if applicable):

Non-Profit (if applicable)

YesNo

Number of PSAs Submitted*

Type "0", if none

Content Information:*

Video and/or Audio Information

Submit your Google Drive or Dropbox download link

For Multiple Submissions - Please copy the virtual folder link.

Airing Duration

Ongoing Airing

Does the PSA contain potentially objectionable content*

Yes (if yes, media will be played during safe harbor hours)No

Media Format:*

Video files: MP4DVD - Data Only

Media Drop-off:*

Ingest ComputerDrop-off MailboxUploaded OnlineStaff Member

If checked, name of Staff

Additional Notes:

Digital Signature*

I hereby attest that I am authorized to submit this/these content (audio, video and or still graphics) as described for cablecast on Pasadena Media's Arroyo Channel, community access channel. I certify that the above mentioned program/programs do not violate the program content guidelines of The Arroyo Channel Rules & Policies. Furthermore, I assume complete responsibility for this program and its contents and agree to indemnify and hold harmless Pasadena Media, its officers, its employees, and its agents from any and all liability associated with the cablecast of this content(s) including copyright, libel, slander or any other potential liabilities. I understand Pasadena Media may reschedule and/or interrupt my programming for any reason. Pasadena Media is not responsible for media and/or files left over 30 days.

Submission Date*

MonthDayYear

Enter the message as it's shown*

PSA Submission

Submission Agreement