To submit your program for SWTV 15, please complete the following form.
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Home Phone Cell Phone E-mail Text Message
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Yes No
Weekly Bi-weekly Monthly
Electronic File Transmission DVD
Yes No
Has Mature Theme Contains Adult Language Depicts Violence No Disclaimer Necessary

I agree. By checking this box with an ‘X’ and submitting this document electronically, you agree that you have read, understand and will comply with Southwest Suburbs Public Access Channel Cablecast Request Form. I accept full responsibility for all program content and for all claims arising out of the cablecasting of any program I am presenting. I agree to indemnify and hold harmless the City of Edina, identified as “Edina Playback Facility” in the policies and procedures, and its directors, officers, agents and staff; SWSCC, its Commissioners, officers, agents and staff; and Comcast against any such claims arising out of the program I submit or any breach of this statement of compliance. Furthermore, I understand that I may be subject to federal, state, and local laws regarding libel, slander, obscenity, incitement, indecency, unlawful activities, invasions of privacy, copyright or other similar laws.

I have read and agree to the Statement of Responsibility

The Minnesota Data Privacy Act requires that we inform you of your rights about the private data we are requesting on this form. The following data contained on this form will be considered private data pursuant to M.S. 13.548: the name, address, telephone number, any other data that identifies the individual, and any data that describes the health or medical condition of the individual, family relationships, and living arrangements of an individual or which are opinions as to the makeup or behavior of an individual. We need this data to register you for a program and to contact you if necessary. Edina staff will have access to the data you provide to administer the program. You are not legally required to provide the data; however, refusing to supply the data may cause your registration to not be processed. Your acceptance here indicates you have read and understand these rights.

I have read and agree to the data privacy policy

© 2017 City Of Edina, Minnesota