Music Panel
Registration

Note: You must be 13 or older to register. Thank you!

1

Please select a Username (username must be one word).


2

Please select a password. For security, your password should be at least 6 characters, include both letters and numbers, and be different from other passwords you use to access personal data.


3

What is your email address?


4

What is your first name?


5

What is your last name?


6

What is your gender?

Male
Female

7

What is your birthdate?

Month Day Year

8

What is your zipcode?


9

Which of these radio stations have you listened to at least once in the past week? (please select all that apply)

94.9 WQMX
99.5 WGAR
K 105
97.5 WONE
98.1 WKDD
Kiss FM

10

Which ONE of these radio stations have you listened to MOST in the past week?

94.9 WQMX
99.5 WGAR
K 105
97.5 WONE
98.1 WKDD
Kiss FM

11

How much time do you spend listening to the radio in a typical day?

Less than an hour
1 to 3 hours
More than 3 hours

12

We just want to verify that you know you're signing up to receive e-mail messages from us. Note: All submitted information will remain confidential and will not be used for any other purpose.

Yes
No