Non-Profit Organization/Volunteer Fire Company/EMS Organization Message Submission Form

Instructions: Please print your completed form, sign, and fax to C-NET at (814) 238-5368 or send by mail to C-NET 243 S. Allen St. Suite 336, State College, PA 16801

Date Message is to START AIRING: 

  Year:

 

Date Message is to STOP AIRING:   

  Year:

 

One message consists of up to two screens airing for no more than five days. Additional screens and days are acceptable but will be billed as additional message(s).

 

Name of Organization:              

 

Name of Submitter                  

 

Organization's Billing Address:  

 

City:  

 

 

State:                        Zip:

  

 

Contact Phone Number:  

ext.:   *Please Note* C-NET will contact you by phone to confirm receipt of this form.

 

Email Address: 

 

Please submit the Title of your Bulletin Board message (a maximum of 26 characters - including spaces)

 

Please submit the text of your Bulletin Board message (up to a maximum of 80 words) in the desired layout as applicable.

 

Notes:

 

 

If you would like a Picture/Logo/Graphic to appear as part of your bulletin message, it must be sent to CNET via E-mail to cnet AT centreconnect DOT org.

 

Will a Logo/Graphic be sent via email to cnet@centreconnect.org? (.jpg or .bmp formats are preferred)     

 

 

 

In consideration of the provisions of the Bulletin Board Service you and your organization does hereby jointly and severally release and hold harmless C-NET from any and all liability and from any causes of action for damages which may arise from the publication of the information delineated above (as “Text”).  The undersigned hereby affirms that he/she understands and assumes all of the risk consequent upon publication; and he/she further affirms that he/she assumes responsibility for any damages accruing.

 Signature: _______________________________________  Date: ___________ 

Instructions: Please print your completed form, sign, and fax to C-NET at (814) 238-5368 or send by mail to C-NET 243 S. Allen St. Suite 336, State College, PA 16801

*Please Note* C-NET will contact you by phone to confirm receipt of this form.