Sponsor A Program

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone

Program Name

Program Length

Type of Program

Series

Single Program

Producer

Does your program contain material that may be inappropriate for children?

Your program must be played during safe harbor hours (11:00 p.m. – 5:00 a.m.) if your program contains nudity, sexual content, obscene language, graphic violence, or images unsuitable for children.

Yes

I agree to the terms and conditions contained in this form.

Signature

I hereby indemnify and hold harmless CTM, its staff and Board of Directors for any and all liability, or other injury including all reasonable costs of defending claims and litigation arising from or in connection with, claims for failure to comply with any applicable laws, rules, regulations, or other requirements of local, state or federal authorities; for claims of libel, slander, invasion of privacy or infringement of common law or statutory copyright; for unauthorized use of trademark, trade name or service mark; for any injury or damage in law or equity, which claims result from the user/producer’s use of equipment and/or access channels; and for any other losses, claims, damages, liabilities or amounts paid in settlement of pending or threatened litigation which arises out of or are based upon the content of programming herein furnished of produced.