Public Service Announcement

The undersigned understands and agrees that this request for a Public Service Announcement on any assigned GPA-TV channel will be granted where time and space are available.

Gillette Public Access Television will allocate the time available for Public Service Announcements on GPA-TV channels in a fair and equitable manner to those non-profit organizations that would be of interest to the general public in its service area.

Organization

Position

Address

Address or Location

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Sponsor

Purpose

Benefit(s) for:

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Stop Date

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It is the responsibility of the applicant to update any information changes to Gillette Public Access Television.

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.