Music PanelRegistration 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 1 - Jan 2 - Feb 3 - Mar 4 - Apr 5 - May 6 - Jun 7 - Jul 8 - Aug 9 - Sep 10 - Oct 11 - Nov 12 - Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 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 FM WQMX 99.5 FM WGAR 106.1 FM The Bull 105.1 FM WQXK K-105 WKDD 98.1 FM WONE 97.5 FM WQAL 104.1 FM WTUZ 99.9 FM WDOK 102.1 FM 10 Which ONE of these radio stations have you listened to MOST in the past week? 94.9 FM WQMX 99.5 FM WGAR 106.1 FM The Bull 105.1 FM WQXK K-105 WKDD 98.1 FM WONE 97.5 FM WQAL 104.1 FM WTUZ 99.9 FM WDOK 102.1 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