Legislative Assembly for the Australian Capital Territory	Request to broadcast, or record for broadcast, the public proceedings of the Legislative Assembly and its committees 	
To be submitted to the Clerk of the Legislative Assembly	
Name:       	
Network/Broadcaster/Department/Newspaper/Other:         	
Mailing Address:     	
Date: 	
Telephone:    	Fax: 	   Audio 			 Visual                	
Details of request:	

I acknowledge that I have read, understood and accepted the Guidelines for recording and broadcasting the public proceedings of the Legislative Assembly and its committees which are published on the Legislative Assembly’s website.

I undertake to ensure that members of the organisation which I represent will abide by those guidelines. 

	

Signed	
Date lodged:

             /                /	Approved

  YES    /     NO:	Clerk’s Signature

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