Request for Taping and Broadcast

2. Requests must be submitted four weeks prior to the event for consideration. Please be detailed in describing your event and the benefits to the community.

4. Contact Name

6. Phone Number

7. Email

9. Name of Event

11. Date and Time of Event
    Date and Time of Event

    Date and Time of Event

12. Location of Event

14. Length of Event

15. Start Time
    Start Time

16. End Time
    End Time

18. Number of Individuals Speaking or Performing

    i.e. Number of microphones required for speakers at podium.

22. Name and number of contact person at event location if different from Contact Name above

24. Name

25. Phone Number

27. Describe your event purpose, number of people participating, etc.

    Please be detailed in the answers you provide. Incomplete forms are not considered.

29. Describe any benefits to the community if your event is aired on Riverside TV.

31. If the public address system is supplied by organization - Please let us know whether the PA system you will be using has the capacity for audio output jacks to be accessed by Riverside TV for audio feeds to our cameras.

    If you have any questions regarding this form, please direct them to the Village of Riverside at 708-447-2700.

33. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Electronic Signature

Leave This Blank:


37. Submit

* indicates a required field