Public Service Announcement Request Form

Intro text describing requests for Public Service Announcements from community 501C-3s Conditions Paragraph Form Instructions
	ORGANIZATION
Name of Organization *
Email Address *
Street Address *
City *
Zip Code *
Primary Purpose of Organization *
How long has this organization been in service? *
Have You Worked With Someone At KSCO Before?
	CONTACT INFORMATION
Contact Name *
Contact Phone Number *
Contact Email Address *
	EVENT INFORMATION
Event Title *
Event Start Date *
Event Start Time *
Event End Date (if applicable)
Event End Time (if applicable)
Describe event, including who will benefit, sources of funding, other pertinent details. *
Will you be buying advertising space or time in other media for this event? *
yesno
Please verify you're not a robot by typing in the letters you see here. * Please type in the BLACK LETTERS ONLY.

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2300 Portola Drive, Santa Cruz, CA