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BKAT TV Playback Request Form

  1. BKAT_logo.jpg

  2. (Where people can get more information about this program)

  3. Who You Are Representing

  4. Program Information

  5. Exact Length of Program

  6. Source

  7. Format

  8. Potentially Offensive Material

  9. Agreement

    I certify that the information on this form is true. I agree to abide by the provisions of BKAT policies and procedures including those set forth in the current Policy Handbook. I have secured, or am able to secure, written permission for cablecast rights of all copyrighted material contained in this program(s). I assume full responsibility for any disputes or community controversy. I agree to work to resolve those disputes and hold harmless Bremerton Kitsap Access Television and any of its funding entities, both individual and organizational, for any damages that I may incur from the cablecast of this program. I understand that potentially offensive material will air after midnight. I understand this tape will air no more than 4 times in one 6-month season. I agree to pick up tape/DVD within three months of final playback or program will be discarded. I agree that BKAT reserves the right to release information about this document.

  10. Electronic Signature*

    By clicking the below "Submit" button, I am signing this application electronically.

  11. Leave This Blank:

  12. This field is not part of the form submission.