JACK FM Music Juror Registration

Contact Information

*Your Name:

*First

*Last
*City/State/Zip:

*City/Town

*State/Province

*Zip/Postal
*Country:
Home Phone:
Work Zip/Postal:
Work Phone:
Personal Information

*Sex:      
*Date of Birth:

Day

Month

Year
Music Style Test

Please click on the PLAY button to listen to each of the following styles of music. Then, answer the following question for each style of music:  How often would you listen to a station that plays this style of music?
Users of Internet Explorer may need to click on the PLAY button twice to start the music.
Media doesn't play?
*Listen? [Music Style A]:
Media doesn't play?
*Listen? [Music Style B]:
*Of the two music styles you've listened to, which is your FAVOURITE?
Desired Log In

*Email:
*Password:
*Confirm Password:

The contact information you submit is confidential. It will only be used for 96-9 Jack FM and will not be provided to any other party. Your participation in surveys and reception of emails depends exclusively on the information you provide to us in this application or subsequent modifications to your profile. Your personal information is being collected using technology provided by Media Score, and is being stored on computers maintained by Media Score. Federal law requires 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.
 




Copyright © 2010 MediaScore, Inc. All rights reserved.
The website or parts thereof may not be reproduced in any form, stored in a retrieval system, or transmitted in any form, by any means - electronic, mechanical, photocopy, recording, or otherwise - without prior written permission of Media Score, Inc.