Public Service Announcement Request Form

ORGANIZATION

Name of Organization(*)
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Street Address(*)
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City(*)
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Zip Code
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Primary Purpose of Organization(*)
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How long has this organization been in service?
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Have You Worked With Someone At KSCO Before?
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CONTACT INFORMATION

Contact Name(*)
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Contact Phone Number(*)
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Contact Email Address(*)
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EVENT INFORMATION

Event Title(*)
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Event Start Date(*)

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Event Start Time(*)
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Event End Date

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Describe event, including who will benefit, sources of funding, other pertinent details.(*)
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Will you be buying advertising space or time in other media for this event?(*)
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Please verify you're not a robot by typing in the letters you see here.(*)
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2300 Portola Drive, Santa Cruz, CA

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