B105.1

You can help choose the music you hear on B105.1

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First Name

Last Name

Email Address

Gender

Female

Male

Birth Date

- - (Use 4 digits for the year)

Ethnicity

why?

Zip Code

In an average week, how much time do you spend listening to the radio?

Fewer than five hours per week
Five to 10 hours per week
More than 10 hours per week

Which of these stations have you listened to in the past week? (select all that apply):

B105.1
92.5 FM The Fox
Mix 94.1
97.3 The Wolf
Q102

Which of these stations is your overall favorite for music, the one you listen to most when you control the radio?

B105.1
92.5 FM The Fox
Mix 94.1
97.3 The Wolf
Q102

How often do you send/receive email? (personal and/or business):

More than once per day
Once per day
A few times per week
Once per week
A few times per month
Once per month

How often do you surf the web?

More than once per day
Once per day
A few times per week
Once per week
A few times per month
Once per month

Comments about B105.1:

The contact information you submit is confidential. It will only be used for B105.1 and will not be provided to any other party. You may remove yourself at anytime. Members must be at least 13 years old. Members are also required to provide truthful information. We will reject duplicate entries or any entry that we discover to be false or fraudulent.

Due to new federal laws, we will not accept any email address that is to be used for messages sent directly to a mobile device. Any such email address will be rejected. Messages that are forwarded to a PDA, such as a BlackBerry or Palm Pilot, or a cell phone from an email address that is not directly associated with a mobile device are not effected by this policy.