STATION CALL  LETTER:

DIAL POSITION:

FORMAT:

CONTACT:

MAILING ADDRESS:

CITY:

STATE:

ZIP:

PHONE:

FAX:

EMAIL (This is where the MP3 File of the advertisement will be sent):

Number of 30 second spots to be run:

Cost per spot:

Total advertising value:

Proposed advertising schedule:

Number of Tubing Passes requested Value $14.95 each (Max 100)