Community Programming Request

Request video coverage of a community event.

Requester's Name*
First Last
Requester's Email Address*
Enter Email Confirm Email
Organization*
Not-for-profit*
- Yes
- No
Is this organization a non- or not-for-profit?
Event
Information about the event for which you are requesting video coverage.
Name of Event
Date of Event*
MM slash DD slash YYYY
Start Time of Event*

: Hours

Minutes

AM/PM
End Time of Event*

: Hours

Minutes

AM/PM
Description of Event*
Describe the event and the community benefit from its coverage.
Speakers and Presenters
Permission*
The sponsoring organization is responsible for getting permission to record and televise this event.
- I understand and agree
On-site Contact
Information about a contact person who will be on-site during the event.
Name*
First Last
Cell Phone*
Email*
Enter Email Confirm Email
Release
Release of Liability*
I agree to release all City of North Liberty staff and volunteers from any liability and realize that the requested program may be edited for content, length, and/or clarity at the City’s discretion.
- I understand and agree

Save and Continue Later

Event