Animal Radio® Show and Feature Affidavit of Airplay

Name of person completing this form
Your Email Address
Your Phone #
Radio Station Call Letters
Market/Station ADI
Method of Delivery
Show Number or Feature(s) Name
Air Dates (MM/DD/YYYY)
Air Times (Start-End) -

By entering your name, you are signing this affidavit. You agree that:
-Programming aired between 6am and 10pm.
-Full program, spots, sponsorships, billboards and commercials aired.
-Programming aired in accordance to affiliate agreement.
-You're authorized to sign this document.
-Information supplied on this document is correct.
Type Name:
Your affidavit hasn't been submitted until you receive a confirmation page.
All fields must be completed!
You may need your affiliate USER NAME and PASSWORD.
If you have trouble with this form, please call 805.772.1314.