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SUNDERLAND TELECOMMUNICATIONS

REQUEST FOR PROGRAM TAPE COPY

Please print this form on your printer. To submit form either:

1. Drop the form along with payment into the Telecommunications mailbox at the Town Office.

2. Mail the form along with payment to: Telecommunications Committee, 12 School Street,

Sunderland, MA 01375

** Please Print or type all information** Date Rec’d: ________________

Name:______________________________________ Tel. # :____________________________

Address:______________________________________ Fax #: ____________________________

______________________________________ E-mail:____________________________

Affiliation: _______________________________________________________________________

Title of Program requested: __________________________________________________________

Date of Program: __________________________________________________________________

Purpose of this request: _____________________________________________________________

Send Tape to: (name) _____________________________________________________________

(Address) __________________________________________________________

___________________________________________________________

Special Instructions / Comments: ___________________________________________________

__________________________________________________________

__________________________________________________________

There will be a $25.00 charge for each tape (includes dubbing, shipping & handling)

Payment by check, cashiers check, or money order made out to: Town of Sunderland

No credit cards or cash accepted.

(NOTE: The Telecommunications Committee holds no guarantee of video and or audio quality of

recorded meetings. All tapes of recorded meetings will be archived for a minimum of 60 days from

the recorded date. Requests after 60 days from recording will not be accepted.)