"On-Line" Distribution Agreement Form

Download this form

CALLS
FREQ
MOD
 AM | FM | Internet
ADDRESS
CITY
STATE
ZIP
CITY OF LICENSE
COURTESY TITLE
FIRST NAME
LAST NAME
PHONE
FAX

E-MAIL ADDRESS
WATT
POPULATION OF COVERAGE AREA
ESTIMATED AUDIENCE
 AVG. QTR. HR. when show airs
SCHEDULE FOR FAMILY HEALTH
 A Mon-Fri schedule is assumed.

SPONSOR / UNDERWRITER
FORMAT
COLLEGE STATION?
E-MAIL
WEBSITE
 http://
AGREEMENT
 By submitting this form you certify that your station plans to broadcast Family Health, a series of 2 1/2 minute programs featuring information about health, without abridgment.
  Agree  Do Not Agree
DISTRIBUTION CD Mailed to Station Download from web site
  If you discontinue broadcasting the series, please notify the program producer.  This will help us keep our distribution list as accurate and up-to-date as possible.

COMMENTS ABOUT THE SHOW

  If you do not get a confirmation page - your submission did not send. Please download the DAF form and return via fax or mail.