Bath Community Television

443-8387 4 Sheridan Road, Bath, Me. 04530 Fax 443-8361

Bulletin Board Application and Information


Organization Name _____________________________________________

Contact Person ________________________________________________

Address _____________________________________________________

Telephone ______________________ E-Mail Address_________________

Requested Run Dates: Start: Date _________________

Until: Date _________________

Information for Display: (must include "For more information" Telephone Number)










I hereby represent that I am an authorized person from the above named organization and have the capibility of authorizing this information to be displayed on the Bath Community Television Channel. Furthermore I hold the staff and voluenteers harmless for failure to display. errors in display,other acts, or omissions that preventthis information from being displayed on the requested days and dates.

I understand nothing will be displayed which contains for-profit information.

Signature______________________________ Date _______/_______/_________



Date Received _____/_____/______ Authorization Dates Content

BCTV 701 10/99