Raymond Community Television Raymond, NH

4 Epping St. Raymond, NH 03077 603-895-6405 www.raymondtv.org

CABLECAST REQUEST FORM
Form RCTV-3

Producer Name			Phone
E-Mail
Project Title
Videotape Format	q VHS/SVHS	q DVD		q Mini DV
Desired Initial Cablecast Date		Desired Initial Cablecast Time
Desired Replay Cablecast Dates		Desired Replay Cablecast Times
Please list any possible controversial content

Producer Signature ___________________________________ Date___________