Requestor Information

Name of Requestor:

Organization/Department:

Address:

Phone Number:

FAX Number:

Email Address:

Please be aware there are charges for this service. For more information on rates please choose the following category from the list below:

Invoice Information
Bill to:

Name:

Organization/Department:

Address:

Phone:

FAX:

Email Address:

Satellite Program Information

Title of Satellite Program:

Broadcast Date:

Broadcast Test time (usually 1/2 hour prior to program start):

Broadcast Time: to

Time Zone: EDT EST CDT CST MDT MST PDT PST HST

Technical Coordinates (please check with the producers of the teleconference for this information. DLUS needs this information to verify whether LLC can "see" the satellite bird).

Type of Request:

Request LLC to downlink satellite feed and DLUS to transmit feed to Honolulu CC Kapiolani CC Kauai CC Leeward CC Maui CC MCC Hana Education Center MCC Lanai Education Center MCC Molokai Education Center UH Hilo UH Center at West Hawaii (Kona) Windward CC

Request DLUS transmit feed from Honolulu CC Kapiolani CC Kauai CC Leeward CC Maui CC MCC Hana Education Center MCC Lanai Education Center MCC Molokai Education Center UH Hilo UH Center at West Hawaii (Kona) Windward CC to LLC for uplink

Clearances from Teleconference Producers

It is the responsibility of the requestor to obtain the appropriate clearance(s) from the producer of the teleconference, if requesting to send this program to multiple sites, or sites other than the campus where the satellite dish is located.

Have you obtained the appropriate transmission clearance(s) from the producers? N/A Yes No

Would you like a videotape copy of your program? N/A Yes No

It is the responsibility of the requestor to obtain taping rights from the producer of the teleconference.

Have you obtained taping rights from the producer to record this teleconference? N/A Yes No