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Public Channel Application TIME REQUESTED BY: Name JAIME DAVIDOVICH Address 152 WOOSTER NEW YORK 10012 Zip Code 10012 Telephone 212 254-4978 (area code) (home) (business) Name and address of principle officer and title, applicable to organizations only. Name _______________________ Address ____________________ Telephone __________________ PROGRAM TITLE AND BRIEF DESCRIPTION: EXPLAINS MY WORK AND "BASEBOARD" THE WASHINGTON PIECE CHANNEL: C ____ D ______ Day(s) and Time(s) of the week requested: Day: Mon __ Tues __ Wed __ Thurs __ Fri __ Sat ___ Sun __ Time: ____ ____ _____ ____ ____ ____ ___ Lenght of program in minutes: 22 Interconnect? [X] yes [ ] No Period of Application: Start_____ End _____ Have you signed the contract? Yes _____ No _____ IF YOUR CONTRACT IS NOT SIGNED, YOUR PROGRAM WILL NOT BE PLAYED. Applicant's Signature Jaime Davidovich Date 1/5/76 (List on rear of page any persons under 21 years of age appearing in program)