Coverage Request Form

*Please note: this form does not guarantee coverage.
Contact Name *
Home Address *
Please provide us with your personal home addressStreet AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Organization Name (if applicable)
Email *
Phone *
Name of Event *
Location of Event *
Brief Description of Event *
Date of Event *
Event Start Time *HHMMAM/PM
Event Projected End Time *HHMMAM/PM
Time crew can get into location to setup equipment (1 hour beforehand is preferred)HHMMAM/PM
Do you have a Producer Agreement on file with LMC-TV?
YESNO
Do you have permission (from a presenter or speaker) to tape and air this event?
YESNO
Please select ONLY ONE option below regarding your request for event coverage: *
I am not willing to pay and am requesting a volunteer record this event (coverage NOT guaranteed)I am willing to pay an experienced camera person a $100.00 stipend (plus 15% payroll processing tax & $5.00 admin fee) to secure coverage.