21 Academy Avenue, Atkinson, NH 03811

COMMUNITY BULLETIN BOARD REQUEST FORM

Atkinson Community Television provides individuals or organizations with the opportunity to inform the public of its activities through the Community Bulletin Board (CBB). This electronic print provides the community with an important communication tool.

Anyone wishing to have an announcement on the CBB must complete this request form and return it to the Atkinson Community Television at least 10 days in advance of the desired airtime. Request may be mailed or delivered to the above address.

The CBB is prohibited from containing advertising material promoting the sale of commercial products or services. This includes advertising by or on behalf of candidates for public office or party.

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Name: ________________________________________________________________________

Organization: __________________________________________________________________

Address: ______________________________________________________________________

Telephone: (H) ____________________________ (W) ________________________________

Air Time Request: Date From: ______________________ Date To: ______________________

Title/Heading:__________________________________________________________________

Copy: ________________________________________________________________________

______________________________________________________________________________

Applicant’s Signature _____________________________________ Date: _________________

Authorization: ___________________________________________ Date: _________________