About You
First Name:
Last Name:
Email:
Organization:
Address:
City:	State: Zip:
Telephone:	Fax:
Schedule Your Video
Date:	(choose a Wednesday)
Time:	2pm 4pm
Location:	At My Location At WinTV
Payment Method:	Credit card online Credit card by phone Drop off a Check Mail in a Check
Agree
	I agree to be filmed myself or have an employee available and ready to film
	I understand that this agreement includes: Video shoot at your location or in studio - max 1 hour Video editing down to 3-5 minutes - max 1 hour DVD copy of your video Display your video on the Chamber website for one year in: The Member Directory The Video section Your video will be shown on WinTV channel 5 twice a week, at varying times, for one year* Includes a spot in the WinTV Business Directory online and on TV
Signature - Date

*To be aired on Win-TV, your content must adhere to public access television policy.