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Cablevision of:
 
Applicant Name:
 
Program Name:
 
Date(s) requested:  Set-up time:  End Time: 
 
Alternate date:  Set-up time:  End Time: 
 
Please list names of production crew and guests:
 
Producer:
 
Director:
 
Technical Director:
 
Audio:
 
Camera:
 
Camera:
 
Camera:
 
Floor Manager:
 
Graphics:
 
Video Operations:
 
Assistants:
 
Guests:
 
Estimated time of crew arrival:
 
Are crew members trained
and qualified Access Users?
Yes  No
I have read the Cablevision Access Rules and understand that this Application must be submitted at least fifteen (15) days prior to requested studio date. I also understand that a completed Access User contract and Program Application and Outline must be submitted at least fifteen (15) days prior to requested studio date.
Applicant's Signature: ________________________________________

Date: ____________
Access Department Approval: ___________________________________

Date: ____________
Access Department Head Approval: ___________________________________

Date: ____________

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.