Please complete this form even if you are only able to respond to one or two questions.
(Required fields)
First Name: Last Name: Mailing Address: Mailing Address 2: City : State : Zip: Daytime Phone: Evening Phone: E-mail Address: Fax:
Do you support NOW creating a Feminist Communications Network? Yes No Would you financially support the Feminist Communications Network? Yes No Do you have any progressive/feminist programming in your area? Yes No Please list: Radio:
TV:
Cable:
Do you have any expertise in hosting, programming, producing, writing, camera, sound, lighting, graphics, animation, Avid/Media 100 or other technical/multi-media software/hardware skills?
List skills experince: Radio:
Multi-Media:
Do you have any contacts who would commit to broadcasting feminist programming? Yes No List contacts: Radio:
What are the requirements to use public access radio equipment in your area? What are the requirements to use public access TV/cable equipment in your area? List your favorite feminist/pro-women/girls issues web sites: Do you design or manage web pages? Yes No List skills and experience below: Do you have any contacts in the field of Internet/web page creation and management? Yes No List contacts:
You can also print this form and return it to: FCN Survey, NOW, 733 15th Street NW, 2nd Floor, Washington, DC 20005.