KBA Reimbursement Form

Name:
Company:
Phone:
Make Check Payable to:
Street Address or P.O.Box:
City:
State:
Zip:
Event Attended: Country Radio Seminar
NAB Show, Las Vegas
RAB Radio Show
Small Market TV Exchange
Enter Date / Description of Expenses / $ Amount:

TOTAL AMOUNT DUE:

ATTACH ALL APPLICABLE RECEIPTS and COPY OF NAME BADGE.

You will have the opportunity to verify/edit your entries, and to attach files on the next page.
You may also submit the form and documentation by mail (DOWNLOAD PRINTABLE FORM) to:
Kentucky Broadcasters Association
101 Enterprise Dr
Frankfort KY 40601You may also submit documentation by email: kba@kba.org