BOLINGBROOK COMMUNITY TELEVISION (CHANNEL 6)

PLEASE CLEARLY PRINT YOUR MESSAGE BELOW.

UPON APPROVAL, YOUR MESSAGE CAN APPEAR AS YOU PREPARED IT 
FOR BOLINGBROOK COMMUNITY TELEVISION, CABLE CHANNEL 6.

NAME: ________________________________________________________

TELEPHONE NUMBER: _________________________________________ 

ORGANIZATION: _______________________________________________

DATE YOU WOULD LIKE THE MESSAGE TO APPEAR: ______________

DATE YOU WOULD LIKE THE MESSAGE REMOVED: _______________

MESSAGES MAY ONLY APPEAR FOR A MAXIMUM OF 2 WEEKS.
PLEASE TRY TO CONDENSE MESSAGES SO THAT THEY DO NOT 
EXCEED A MAXIMUM OF 2 PAGES.

PLEASE RETURN YOUR COMPLETED FORM TO:

VILLAGE OF BOLINGBROOK
EXECUTIVE DEPARTMENT
375 W. BRIARCLIFF RD.
BOLINGBROOK IL 60440
(630) 226-8417


PRINT MESSAGE HERE: