NAB Form 138-18 issues

AGREEMENT FORM FOR
NONHCANDIDATEIISSUE ADVERTISEMENTS

 

 

Station and Location: Date:

V776. 0c 3/ 7/1;

 

 

,1 National Media Research, Planning, Placement

 

 

do hereby request station time concerning the following issue:

 

 

Coalition for Medicare Choices

 

 

 

 

Time of
Broadcast Day, Times per Number of
Length Rotation or Days c'ass Week Weeks
Package

 

See schedule see schedule see schedule see schedule see schedule see schedule

 

 

 

 

 

 

 

This broadcast time will be used by: Coahtlon for medlcare 

 

Copyright 2013 by the National Association of Broadcasters. May not be copied. reproduced or further distributed
1

NAB Form Issues

THIS PAGE MUST BE COMPLETED FOR PROGRAMMING THAT
A POLITICAL MATTER OF NATIONAL 
FOR ALL OTHER ISSUE ADS, PLEASE GO TO PAGE 3.

Programming that ?communicates a political matter of national importance?
includes (1) references to legally qualified candidates (presidential, vice
presidential or congressional); (2) any election to Federal of?ce any
references to ?our next senator?, ?our person in Washington? or ?the President?);
and (3) a national legislative issue of public importance Affordable Care Act,
revising the IRS tax code, federal gun control or any federal legislation).

 

 

Do?es?the? programming (in whole or in part) communicate ?a message
relating to any' political matter of national importance??
5 Yes - No

 

 

For programming that "communicates a message relating to any political matter of
national importance," list the name of the legally quali?ed candidate(s) the programming
refers to, the of?ces being sought, the date(s) of the election(s) and/or the issue to
which the communication refers (if applicable):

 

 

Medicare Choices

 

 

 

I represent that the payment for the above described broadcast time has been furnished
by (name and address):

 

 

601 Ave
Washington, cc 20004

 

 

and you are authorized to announce the time as paid for by such person or entity
(hereinafter referred to as the ?sponsor").

List the chief executive officers or members of the executive committee or the board of
directors below (or attach separately):

 

Exec Director: Beth Leonard

 

 

For programming that "communicates a message relating to any political matter of
national impedance,? attach Agreed Upon Schedule (Page 5)

Copyright? 2013 by the National Association of Broadcasters. May not be copied. reproduced or further distributed
2

NAB Forrn issues

TO BE COMPLETED FOR ALL ADVERTISEMENTS

THIS DOES NOT OR PEEMIT DISCRIMINATION ON THE
BASIS OF RACE OR IN THE PLACEMENT OF 

The Sponsor agrees to indemnify and hold harmless the station for any damages or
liability, including reasonable attorney's fees. that may ensue from the broadcast of the
above?requested advertisemen?s). For the above-stated broadcas?s), the. sponsor
atso agrees to prepare a script, transcript, or tape, which will be delivered to the
station at least before the time of the sohedutod broadcasts.

To BE SIGNED BY 15:15 ADVERTISER (SPONSOR)

Date frgnature Contact Phone Number

TO BE SIGNED BY STATION REPRESENTATIVE

 

 

?ccepted [3 Accepted in Part Rejected
9% 572%; fun arm
Signature Printed Name Time

Copyright 2013 by the National Association of Broadcasters. May not be copied. reproduced or further distributed
4

Fox Television Stations, Inc.
Political Public File
National Issue/Third?Party Federal Candidate Advertisement

 

Does the advertisement refer to a legally-quali?ed candidate for federal office?

No

 

If so, what is the legally-quali?ed candidate?s name?



 

What of?ce is the candidate seeking?

F?n?u

 

What election does the advertisement refer to?


 

Does the advertisement refer to a national legislative issue?



 

If so, what is the issue (or issues)?

Mariners, Chow)

 

Who is the sponsor of the advertisement?

imam Sol meet one Glow

 

Who are either the chief executive of?cers or (ii) members of the executive committee or 
members of the board of directors of the Sponsor?

[tenude 

 

 

List the name, address, and phone number of the contact person buying the time. 
Core (LET)
Mohmal \q trimaran Omnm @la umgrd- .

 

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