Satellite Request Form (PBSALS Only)

Please note:
Please provide all required information (* indicates required field) and submit the form at least 48 hours in advance of scheduled downlink. (Weekends/holidays not included). An IMR staff member will confirm the availability of the requested program. For more information see Satellite Downlink Page.


Today's Date:
Name:*		Department:*
Phone:		E-mail:*
Box #:

Title of Satellite Broadcast Program:*

Broadcast Date:*

Start Time (CT):*

End Time (CT):*

Test signal time (CT):*

Do you wish to have this program recorded on videotape?*

Yes

If yes, please enter your initials to verify you have copyright permission to record this program.

Provide own tape

Media Center tape

Do you wish to arrange a direct viewing of this program?*

Yes

Preferred site of viewing:

(You may call 2725 for more information about scheduling rooms)

	LRC Room T (up to 35 people - call Dr. Schmidt 5191 for availability)
	LRC Room 221 (call Scheduling Center 5800 to reserve room)

Other room location

Satellite Technical Information

Satellite:

GE-3 Digital

Channel / Transponder:

503

Polarity:

Vertical

Test signal time (CT):

7:20am - 8:00am

Audio Frequency:

6.2 / 6.8 (MHz)

Trouble phone # (day of broadcast):

800-257-2578

Copy of license receipt must be provided before transmission date
(Please forward any program registration information or forms to IMR Box 33)

License Fee:*

Paid By:*

Date Paid:

Additional Information:

NOTE: MTSU is a PBSALS member and is eligible for member discount prices