FILL OUT THIS PAGE AND SUBMIT IT TO RENEGADE RADIO!
First Name
Last Name
Address
Apt/Suite
City
State
Zip
Email
Phone
(Include area code)
Age
Sex:
Male
Female
Birthdate
(Month/Day/Year)
List your three favorite music groups/artists:
1:
2:
3:
Where do you most listen to the radio?
Home
Car
Work - Other:
When do you most listen to the radio?
Morning
Afternoon
Evening /
Weekdays
Weekends
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