Affidavit Form | FSU Affiliates

Select the sports network with which your station is affiliated

Please select the network with which your station is affiliated.

Station Call Letters

Please include translators and HD signals if applicable.

Is this station streamed?

Yes

City/Market

State

Broadcast Month

Check programs that aired in accordance with station's affiliation contract.

Football

Coaches Show (Football, Men's Basketball)

Basketball - Men

Check all that apply.

If any games, programs, or commercials indicated above did not air as scheduled, please list those programs, as well as dates and times of make-goods. Please be specific.

Example: Coaches Show on 9/1 was rebroadcast in its entirety on 9/2 at 7:00 p.m. Commercials in Daily Show on 8/27 and 8/28 were made good on 8/29 between 3-4pm.

Additional Comments

Please let us know if there are any changes the Network needs to be aware of (example, pending technical or ownership changes).

This affidavit is being electronically signed by a duly authorized employee of the radio station, and by signing warrants this proof of performance is accurate and truly reflects the information contained in the permanent logs of this station.

Full Name of Authorized Station Representative

This serves as your digital signature.

Titile

Example: GM, OM, PD, Traffic Manager

Email Address

You will receive a confirmation email for your records.