Application for Program Broadcast Rights

The following information must be completed before any broadcast rights to Milner-Fenwick videos are provided. Upon receipt of your completed form, we will contact you with a quote for your particular needs. Feel free to discuss any questions you may have with your customer service representative:

The rights and limitations of use are subject to the Standard Rights and Limitations of Broadcast Use unless other terms are provided by Milner-Fenwick. You will be required to sign an agreement similar in terms with this document before broadcast rights are granted.

 

Your Contact Information *required fields
*Name:
*Title:
*Company:
*Address:
*City:
*State:		Select... International Location Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Zip code:		-
Country + Postal code: (if other than US)
*E-mail address:
*Work phone:
Fax:

 

Facility/Institution Information (if different) Contact person: Facility/Institution:   Street address:   City:   State:   Select... International Location Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip code:   - Country + Postal code: (if other than US)

Additional Location (if needed) Contact person: Facility/Institution:   Street address:   City:   State:   Select... International Location Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip code:   - Country + Postal code: (if other than US)

 

Programs Requested *required fields
*Number of programs:
*Product codes OR Full program titles: (example: HA66 OR Heart Surgery: Preparing for Your Surgery)
*Requested start date:
Contract length: (For different contract lengths, make a notation below in "Additional information" and contact your Sales Representative.)		5 years

 

Technical Information *required fields
You will be supplied with VHS analog programs that will need to be encoded into a digital format.
*Where will the tapes be encoded into digital files?		Select... On-site System Manufacturer Other
If other, please provide company name:
*Preferred digital format:		Select... MPEG1 MPEG2 I don't know
*Preferred delivery medium:		Select... DVD-ROM CD-ROM I don't know
Distributor's name: (if applicable)
Please describe your digital delivery system in detail:
*System manufacturer:
*Model number:
*Number of channels:		Select... 1 between 2 and 16 more than 16
Additional information:

I have read and agree with the Standard Rights and Limitations of Broadcast Use. (required)