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New York City Serving New York Submission

YOU MUST REGISTER FOR THE LUNCHEON SEPARATELY HERE

Public Service Campaign Submission Form

Complete a separate form for each campaign submission

Station Call Letters

City of License/Market

Station Contact Name

Contact Phone

Contact Email

Name of Public Service Campaign

Brief Description of Public Service Campaign

Public Service Organization Partner (if any)

Public Service Organization Contact (if any) (email)

Campaign Logo

Campaign Photos

Station Logo

Public Service Organization Logo (if applicable)

1805 Western Ave, Albany, NY 12203

518-456-8888

Office Hours:

Monday - Friday

8:30 AM - 5:00 PM

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