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Cablevision of:
Applicant Name:
Program Name:
Telephone # (Home):
Telephone # (Work):
Tape format: VHS  Super VHS  DVC Pro
Date(s) and Time(s) Requested: 2 non-consecutive sessions of 4 hours each may be booked at any given time with a maximum of 12 hours per week:
First date: Date:   Time: 
Alternate first date: Date:   Time: 
Second date: Date:   Time: 
Alternate second date: Date:   Time: 
I have read the Cablevision Access Rules, and I understand that a completed Access User Contract and Program Application and Outline must be on file for the program being edited during these requested time periods.

Note: Please be prompt in your arrival to and departure from the edit suite and please adhere to your reserved time slot.
Applicant's Signature: ________________________________________

Date: ____________
Cablevision Operations Supervisor: ____________________________

Date: ____________

Time Reserved: _________________________

Please fill out the above form, then click below to print it. Sign and date the form and mail or fax it to your regional access programming office.