PSA Request Form

Organization Name *
Organization Address (if applicable)
Contact Name *
Contact Email
Contact Phone Number *
Mission of Organization (in a few sentences) *
Purpose of PSA (i.e. promoting a specific event, etc.) *
Deadline for PSA *
Choose a Style for your PSA *
If you chose "representative" above, what background would you like for your PSA?
Green screen with a Virtual SetBlack Curtain
Will you need a teleprompter? *
If YES above, please paste your text below
Please upload your LOGO here You can submit either a .png, .jpeg, or .pdf
Please choose a song Visit http://dewolfemusic.com/ and choose a song you would like to use for your PSA.
Do you have a producer agreement on file with LMCTV? *
Request a date to record your PSA *