Listener Advisory Board Registration


Note: Federal law prevents your registration if you are under 13 years of age. Thank you!

Simply fill in the blanks (all blanks are required) and you'll be registered to give us your opinions. It's that easy!

1

 

Please Select a Username (user name can only be one word)

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:

Month Day Year

8

 

Your zip code:

9

 

Which types of stations have you listened to at least once in past week (multiple choices okay):

Northwestern College Radio
Adult Contemporary
Public Radio/Classical
News Talk
Oldies
Top 40

10

 

Which type of station did you listen to MOST in the past week (choose only one):

Northwestern College Radio
Adult Contemporary
Public Radio/Classical
News Talk
Oldies
Top 40

11

 

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