Please read the full FAQs of this Contest  before filling out this form and fully complete all fields before submitting.

Your Full Name
Your Email
Your Age and Birthdate (mm/dd/yyyy)
Street Address
Zip Code
Home Phone
Work Phone
Age Category:

A: Ages 15 to 19B: Ages 14 and younger

List names, roles and ages of all other members of team. Include where they live.:

Category of Video Project:

EducationCommunity ServiceDocumentaryPublic Service AnnouncementProfile of Significant Local Person or GroupHealth PromotionProtecting the EnvironmentLocal HistoryOther

If you checked "Other", you must describe here:
Production Elements

Length of Video (in seconds):
Video Format of Submission:
Anticipated Budget of the Video:
Target Audience for Video:

Brief Description of Content and Purpose of Video:

Agreement and Signature

By submitting this application, I affirm that I read the Frequently Asked Questions (FAQs) governing the CTAC Video Public Service Contest and that the facts set forth in it are true and complete. I understand that if I am offered a prize and choose to accept it, any false statements, omissions, or other misrepresentations made by me on this application may result in my forfeiting the prize. I agree that although I retain all rights of distribution and sales of the video, I will allow Citizens Television (CTV), Comcast and Frontier Communications to air the video at their sole discretion without compensation of any kind.

I am the Lead Producer
I agree to the Terms Stated Above
I have read and understood the Frequently Asked Questions (FAQs), Terms and Conditions of this contest.

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Please print this page for your records before clicking to submit!

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