Alabama Broadcasters Association
Membership Application
Call letters: __________________
Format:
________________________
Frequency/Channel:
_____________
City of License: _______________
Legal Licensee Name (per FCC
filing): ___________________________________________________
Group Owner (if applicable):
_________________________________________________________
GM:
______________________________________________________________
Bus Mgr: _________________________________________________________
Program Director:
________________________________________________
(Chief) Engineer:
________________________________________________
Gen Sales Mgr:
___________________________________________________
Mailing Address:
__________________________________________________
___________________________________________________
Physical Address:
_________________________________________________
___________________________________________________
Phone:
_____________________________________
Fax:
_______________________________________
E-Mail:
_______________________________________
Website:
___________________________________
Other stations owned and/or
operated in the same city of license:
__________________________________________________________________
I, ____________________________ (cardholder) authorize the Alabama Broadcasters
Association to charge my credit card only the charges I request
in written form or
documented conversation.
By signing this form, I authorize this credit card and signature
to be valid for all future
charges I may request
to be placed on said credit card by the Alabama
Broadcasters
Association.
If I authorize multiple charges, I allow this form to serve as a
contract for
each individual
charge. I will notify the Alabama
Broadcasters Association in writing
within seven days of
when I will cease the charging on this credit card, otherwise I am
liable for any
requested charge(s).
_____ Visa _____ Mastercard _____ American
Express
Card Number: ___________________________________ Exp. Date:
_____________
Billing Address: _________________________________________
(Street)
_________________________________________ (City, State, Zip)
Signed: ____________________________
Date: ______________________________
__________________________________________________________________
Mail completed application, along with payment to:
Alabama Broadcasters Association
2180 Parkway Lake Drive
Hoover, AL 35244