1
What is your first name?
2
What is your last name?
3
What is your zipcode?
4
What is your email address?
5
Please tell us your phone number (including area code):
6
What is your birthdate?
Month Day Year
7
What is your gender?
Male
Female
8
From this list of radio stations, what stations to you listen to in a typical week? (Check all that apply)
WONE 97.5
WKDD 98.1
WNCX 98.5
WMMS 100.7
WMJI 105.7
106.5 THE LAKE
WQMX 94.9
9
From this list of radio stations, what station do you listen to most?
WONE 97.5
WKDD 98.1
WNCX 98.5
WMMS 100.7
WMJI 105.7
106.5 THE LAKE
WQMX 94.9

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