Event Request / Permission Form NameFirstLastEmail Address*Phone #?Name of Event:Please Describe Your EventEvent Date:* How Long is Your Event?Under 1 hrAbout 2 hoursAll DayWhat Time? : HHMMAMPMWhere is it happening?*Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP CodeAre you interested in Upgrading to a Sponsored Package?*YesNoCall Me! Let's TalkOur Sponsored Live Streaming Package Starts at $250 for 1-2 hours of event streaming and includes:* Full Event Promotion of live stream through WNYmedia social channels *A Branded URL Specific for your event *Branding and Graphics on live stream *Multiple Cameras angles (up to 3) *Embeddable onto your company's website *Sharable Event Archives via Youtube *Viewer Analytics (**Ad-free streaming is also available for an additional cost**) If you click YES one of our reps will contact you with further details and contracts regarding sponsoring an eventIs there an internet / wifi connection we could tap into?*YesNoNot SureTerms & Conditions*I understand the terms and Conditions as set forth by WNYmedia.netI understand that submitting this form is merely an invitation giving WNY Media Network permission to attend and video stream our event at their leisure to their website at WNYmedia.net. I understand that WNY Media Network reserves the right to decline our invitation for any reason they see fit, including but not limited to another event, schedule conflict, severe weather, act of God, overall interest in event, etc...) I understand that submitting this form is not an official contract for any services rendered by WNY Media Network and that WNYmedia is under no obligation or contract to attend or stream any portion of my event. If I choose to upgrade to a sponsored package, a WNY Media Network representative will contact me in regards to a more formal business contract.