1

Please Select a Username (user name can only be one word)
Try to use something a little unique like your first and last name combined, your hobby, birthday, etc.


2

Please select a password


3

Your first name


4

Your last name


5

Enter your email address


6

Gender

Male
Female

7

Your birthdate

Day Month Year

8

Your zip code


9

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

Q106.3
105.1 Charlie FM/WCHY
WJVL
Oldies 94.9/WOLX
Z104/WZEE
Magic 98/WMGN
96.3/Star Country

10

Which station did you listen to most in the past week? (choose only one):

Q106.3
105.1 Charlie FM/WCHY
WJVL
Oldies 94.9/WOLX
Z104/WZEE
Magic 98/WMGN
96.3/Star Country

11

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

1 hour or less
1-3 hours
More than 3 hours

12

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

Yes
No