First Name		Last Name		Title

MSO		DMA

Street Address (No P.O. Boxes)		Floor / Suite No.

City		State		Zip

Phone		Ext		Fax

E-mail

# of Subs		Spot Rate

Name of Disney & ESPN Media Networks Representative

PLEASE INDICATE HOW THE PROMOTION WILL BE UTILIZED:

Local Ad Sales

Marketing

LOCAL CONSUMER SWEEPS

National Sweepstakes
($25,000 prize)
Local Sweepstakes
(prize selected by you)

Tune-In Period: 11/23-12/25
Sweepstakes Period: 11/21-12/26

300 Tune-In Spots 100-150
Sweepstakes Spots

Order Ballot Boxes. (POP)
Do not select your local winner. Return all entries via mailer sent to you at end of sweeps.
Prizing is shipped to the consumer 4-6 weeks after approval of affidavits and after winner is secured and qualified.

ADVERTISER
INCENTIVE

Advertiser Incentive
(prize selected by you)
Optional: National Sweepstakes
($25,000 prize)

Tune-In Period: 11/23-12/25

300 Tune-In Spots
100-150 Sweepstakes Spots
(if running sweeps)

Optional: Order Ballot Boxes. (POP)
Prizing is shipped to the affiliate 4-6 weeks after approval of affidavits.

INTERNAL
INCENTIVE

Internal Incentive
(prize selected by you)

Tune-In Period: 11/23-12/25

300 Tune-In Spots

Prizing is shipped to the affiliate 4-6 weeks after approval of affidavits.

RUN AN ADDITIONAL 175 TUNE-IN SPOTS TO QUALIFY FOR AN ADDITIONAL PRIZE PACKAGE!

Please confirm if you would like to run the additional spots and take advantage of the bonus:

Yes

*Limited quantities. Available on a first come, first served basis. Limit one bonus per system. Must opt-in at time of enrollment to qualify. Bonus prize cannot be given to consumers.

By submitting my enrollment, I agree to run the minimum 300 spot cross-channel tune-in requirement (between 6:00 a.m. and midnight) from November 23 to December 25, 2011 and will submit an Affidavit of Participation and Performance Summary before my prizing will be fulfilled.

Please note activation materials must be sent to affiliate office.
Activation materials will not ship until you have secured a local sponsor.
Materials will begin shipping the week of November 7th.
Please contact your Disney and ESPN Media Networks Representative before proceeding if you have any questions.

LOCAL CONSUMER SWEEPS

ADVERTISER INCENTIVE

INTERNAL INCENTIVE

ADVERTISER
INCENTIVE

INTERNAL
INCENTIVE