Request For Programming

1. Please complete the following and submit to the Village of Lombard for consideration.

2. Today's Date:

3. Requesting Organization:

4. Contact Phone Number:

5. Contact Email Address:

6. Title of Event:

7. Date of Event:

8. Location of Event:

9. Starting Time of Event: AM/PM

10. Ending Time of Event: AM/PM

11. Brief Description of Event:

12. Please note: If your program is approved for production, The Lombard Channel will provide one DVD copy of the finished program at no charge. If you will be requesting additional copies, please indicate how many and the Communications Division will let you know the duplication fee. Thank you.

    Please note: If your program is approved for production, The Lombard Channel will provide one DVD copy of the finished program at no charge. If you will be requesting additional copies, please indicate how many and the Communications Division will let you know the duplication fee. Thank you.

13. Additional DVD Copies Requested?
    -- Select One --BlankYesNo

14. Additional Comments/Questions?

Leave This Blank:


15. 1. Receive email copy
16. Email address

17. Submit

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