NAB POLITICAL ADVERTISEMENT FORMS (PB-16)

2011(202) 429-5484.

PB-17PB-172011

NAB Form PB-17 CandidatesAGREEMENT FORM FORPOLITICAL CANDIDATE ADVERTISEMENTS(check applicable box)□ FEDERAL CANDIDATE□ STATE/LOCAL CANDIDATETo Avail Themselves of The Lowest Unit Charge During a PoliticalWindow, Federal Candidates Must Sign The Certification On Page 3Station and Location:Date:I, _________________________________________________________________________________,being/on behalf of: ____________________________________________________________, a legallyqualified candidate of the ________________________________________________________ politicalparty for the office of: __________________________________________________________________in the _______________________________________________________________________________election to be held on: _________________________________________________________________do hereby request station time as follows:BroadcastLengthTime of Day,Rotation orPackageDays Class Times perWeekNumberof WeeksTotal Charges:Copyright ©2011 by the National Association of Broadcasters. May Not Be Copied, Reproduced or Further Distributed.1

NAB Form PB-17 CandidatesCANDIDATE CERTIFICATIONIn Order For Federal Candidates to Receive The Lowest UnitCharge During a Political Window, the Following Certificationis Required:I, _________________________________________________________________(name of federal candidate or authorized committee) hereby certify that the programmingto be broadcast (in whole or in part) pursuant to this agreement:□ does □ does notrefer to an opposing candidate (check applicable box). I further certify that for theprogramming that does refer to an opposing candidate:(check applicable box)□ the radio programming contains a personal audio statement by the candidate thatidentifies the candidate, the office being sought, and that the candidate hasapproved the broadcast.□ the television programming contains a clearly identifiable photograph or similarimage of the candidate for a duration of at least four seconds, and a simultaneouslydisplayed printed statement identifying the candidate, that the candidate approvedthe broadcast, and that the candidate and/or the candidate’s authorized committeepaid for the broadcast.______________________________________________________________________signature of candidate or authorized committee____________________________________________________________printed name___________________dateCopyright ©2011 by the National Association of Broadcasters. May Not Be Copied, Reproduced or Further Distributed.3

NAB Form PB-17 CandidatesAGREED UPON SCHEDULE(TO BE FILLED IN ONLY IF STATION DOES NOT ACCEPT ALL OFCANDIDATE’S REQUEST)BroadcastLengthTime of Day,Rotation orPackageDays Class Times perWeekNumberof WeeksTotal Charges:AFTER AIRING OF BROADCASTS:Attach invoices or Schedule Run Summary to this Form showing:(1) actual air time and charges for each spot;(2) the date(s), exact time(s) and reason(s) for Make-Good(s), if any; and(3) the amount of rebates given (identify exact date, time, class of broadcast and dollaramount for each rebate), if any.Note: Because the FCC requires that the political file contain the actualtimes the spots air, that information should be included in the file assoon as possible. If that information is only generated monthly, the fileshould include the name of a contact person who can provide the timesthat specific spots aired.Copyright ©2011 by the National Association of Broadcasters. May Not Be Copied, Reproduced or Further Distributed.4

NAB Form PB-17 IssuesAGREEMENT FORM FORNON-CANDIDATE/ISSUE ADVERTISEMENTSStation and Location:Date:I, ____________________________________________________________________________do hereby request station time concerning the following issue:BroadcastLengthTime of Day,Rotation orPackageDays Class Times perWeekNumberof WeeksTotal Charges:This broadcast time will be used by:____________________________________________________Does the programming (in whole or in part) communicate “amessage relating to any political matter of national importance?”□ Yes□ NoCopyright © 2011 by the National Association of Broadcasters. May Not Be Copied, Reproduced, or Further Distributed.1

NAB Form PB-17 IssuesFor programming that “communicates a message relating to any political matter of nationalimportance,” list the name of the legally qualified candidate(s) the programming refers to, theoffice(s) being sought and the date(s) of the election(s) (if applicable):For programming that “communicates a message relating to any political matter of nationalimportance,” attach Agreed Upon Schedule (Page 3)I represent that the payment for the above described broadcast time has been furnished by:and you are authorized to announce the time as paid for by such person or entity. The entityfurnishing the payment, if other than an individual person, is:□ a corporation; □ a committee; □ an association; □ or other unincorporated group.The names, offices, and addresses of the chief executive officers, directors, and/or authorizedagents of the entity are named below (may be attached separately):I agree to indemnify and hold harmless the station for any damages or liability, includingreasonable attorney’s fees, that may ensue from the broadcast of the above-requestedadvertisement(s). For the above-stated broadcast(s), I also agree to prepare a script,transcript, or tape, which will be delivered to the station at least __________________before the time of the scheduled broadcasts.TO BE SIGNED BY ISSUE ADVERTISER___________ __________________________ ____________________________Date Signature Contact Phone NumberTO BE SIGNED BY STATION REPRESENTATIVE□ Accepted □ Accepted in Part □ Rejected________________________________________________ _________________________Signature Printed Name TitleCopyright © 2011 by the National Association of Broadcasters. May Not Be Copied, Reproduced, or Further Distributed.2

NAB Form PB-17 IssuesAGREED UPON SCHEDULEFor All Issue Advertisements That Communicate a Message Relating to AnyPolitical Matter of National ImportanceBroadcastLengthTime of Day,Rotation orPackageDays Class Times perWeekNumberof WeeksTotal Charges:AFTER AIRING OF BROADCASTS:Attach invoices or Schedule Run Summary to this Form showing:(1) actual air time and charges for each spot;(2) the date(s), exact time(s) and reason(s) for Make-Good(s), if any; and(3) the amount of rebates given (identify exact date, time, class of broadcast anddollar amount for each rebate), if any.Note: Because the FCC requires that the political file contain theactual times the spots air, that information should be included in thefile as soon as possible. If that information is only generated monthly,the file should include the name of a contact person who can providethe times that specific spots aired.Copyright © 2011 by the National Association of Broadcasters. May Not Be Copied, Reproduced, or Further Distributed.3