Priorities USA Action 01.11.13D (13579465141332)_

1 MB·

by  FCC

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RLECTRONIC
POLILICAT, AND ISSUE ADVERTISING
PUBLIC INSPECTION P+ CRCKERT

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APMELP-§ Gece)
AGREEMENT FORM FOR
NON-CANDIDATE/ISSUE ADVERTISEMENTS

‘Station and Location: Date:
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1,_Bfuuty Ketowrite Media
dShereby request sation rime conversing eR

Time of Day,
Broadcast | Rotation or | Days | class | timesper | number
Length Package Week | of Weaks

‘This broadcast time will be used by: Priorities USA Action

Does the programming (in whole or in part} communicate “a
message relating to any political matter of national importance?”

Yes No

up OT Eee mince He Rll
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offices) being somght aud Uc date(s} of ee election(s) (if appRicatleys .

For programming tot “communicates a message sting lo ny plitice mate of acon
importanee,"absch Agreed Upon Scheie (Page 3) "

ropeesent at the payment fo the above desorbed broadcast ve ass heen furnished by:

Fenet An 110) Sth SN, Bd Flor, Weshcglon. DC, 20M; Greg Speed, |

and you are autharized to seiousce the tates paid for by suc person a erty, “Cheenti
oenishiug the prement, if other than indivi yoson, i:

Ta curporation; [ZV comnaitces Cum assostations ] or etter uniacorporated group.

“Tae names, uffices and addzessas ofthe chief executive officers, dscetor. uadtor eutarieed
agents ofthe ety are named below (aay Le ettacied separately)

[THIS STATION DOES NOT DISCIUMINATE OX PERMIT DISCRIMINATION ON IE BASIS
(OF RAGE OR RTANICITY IN THE LLACEMENT OF ADVERTISING,

agree to sn hold harmless the stolen er any damages obit, including

seamuntble aun’ fees, that may ensue from the breadeast af The above rsuerted

‘nivertzement(s), For the aboye-stuted braxdenst(s), Lalso agree to nrepay® seriphy

CGauserips or tape, whieh wil be delivered lu the tation at Test _ —_

‘oefove the time of tie sensduled Lroadeants

TO BE SIGNED BY ISSUE ADVERTISER -
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To BE SIGNED BY STATION REPRESENTATIVE
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