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2. Thank you for your interest in submitting a program for broadcast on the City of Dubuque's public access channel. Please complete this Broadcast Request and Provider Agreement form, identifying the producer, who must reside in the city of Dubuque or be sponsored by someone/organization within the city. After submitting, you'll be able to upload your video. A new form is required for each submission. Staff will notify you once your submission is scheduled for playback. We look forward to sharing your content with the community!

4. Producer's Name*
6. Producer's Phone Number*
7. Producer's Email*
9. Series or Program Title*
11. Program Submission Date
    Program Submission Date
12. Total Runtime of Program
14. Are you submitting this form on behalf of a producer?*

    1. Yes
    2. No, I am the producer.
16. Name of Individual Submitting the Request*
18. Additional Information
20. Dubuque Cable Access Policy and Procedure Guidelines

    Download and review the policy and procedure guidelines.

22. Provider Agreement*

    1. I have read, understood, and agree to the terms outlined in the City of Dubuque Cable Access Policy and Procedure Guidelines, have permission to submit programming on behalf of the producer, and accept that the City of Dubuque is not liable for the submitted video content for playback on the City of Dubuque's public access channel.
24. Video Program File Upload

    After completing and submitting this form, you will be redirecting to a file sharing site where you can upload your video program. Please be sure to name your video file so it is identifiable. 

    Thank you for your interest in sharing your content on our local public access channel!

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field