on behalf of John Hagelin, candidate for the federal office of President

request (Name of Radio Station) ___________________________________

to run his/her 30 second ad without cost pursuant to US Code, Title 47, Chapter 5, Section 312(a)(7) and Section 399(b). The legal requirements to run this ad may be confirmed by contacting Mr. Rod Royce of the FCC's Political Program Office at (202) 418-1440. As required by FCC regulations, this ad contains the voice of the candidate.

Please run the ad (number of) ______________ times before November 7, 2000, preferably at the "top of the hour," and during morning and evening drive time shows such as "Morning Edition" and "All Things Considered."

Name of Requester (Print): ________________________________________

Signature: ___________________________________________________

Date: _______________________________________________________

Address:_____________________________________________________

____________________________________________________________

____________________________________________________________

Phone:______________________________________________________

Fax: ________________________________________________________

Email: ______________________________________________________