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Cablevision of:
Applicant Name:
Date / Time Requested: From:  To: 
Producer Name:
Director Name:
Technical Director Name:
1st Camera Name:
2nd Camera Name:
3rd Camera Name:
1st Production Assistant Name:
2nd Production Assistant Name:
Are crew members trained
and Qualified Facility Users?
Yes   No
I have read the Cablevision Access Rules and understand that this application must be submitted at least thirty (30) days prior to the requested date on this application. I also understand that a completed Access User Contract must be submitted at least fifteen (15) days prior to requested location 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.