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Free Ten Day Trial Radio Station Application This form is only for those persons employed by a broadcast radio station in the U.S. or Canada. If you work for a radio station, but not in the U.S or Canada click here. First name * Last name * Call letters * Moniker/Slogan Dial position * Station format Select CHR Rhythmic CHR Urban Urban AC Urban Oldies Rock Active Rock Country New Country AC Hot AC Modern AC Alternative AAA Pop/Alt Oldies R&B Oldies Rhythmic Oldies 60's/70's 70's Gold 70's/80's 80's/90's Eighties Classic Hits Classic Rock Variety Hits News News/Talk Talk Sports Sports/Talk Big Band Nostalgia Spanish Spanish AC Spanish CHR Spanish Urban Spanish Talk Spanish News Spanish NT Tejano Regional Mexican Tropical NAC/Jazz NPR Classical Christian Christian AC Christian CHR Religious Gospel Childrens Business Agriculture Ethnic College Community Other Various * Job position * Station address * City * State/Province Select Outside U.S./Canada Alabama Alaska Alberta American Samoa Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick Newfoundland New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatachewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon * Postal code * Country * Include area code - if outside the U.S. the country code Station phone * Fax phone RADIO ONLINE will send a test message to confirm the validity your e-mail address. The application will be placed on hold if the e-mail is returned undeliverable E-mail address * Your User Name (25 characters or less) is the unique ID that is used to login to your RADIO ONLINE account. User name * Provide a password that is one word - 12 characters or less Password * In case we need to verify your identity Password Security Question Last 4 digits of your Social Security number? What city were you born in? What is the first school you attended? What is your mother's maiden name? What is your pet's name? What is your favorite sports team? * Enter Your Response * Primary interest Show Prep Promotions Sales Programming Engineering All Areas * * = required information Notice: The information you provide is used for internal purposes exclusively; we do not sell or redistribute registration information. Incomplete registration forms will not be processed or acknowledged. (select when ready to submit) Return to Menu

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