Internet Music Rights for Public Broadcasters: Station Info

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All fields are required unless otherwise noted.

Station Information

Station or Organization Station or Organization Type(s)

Radio

Television

Joint radio and television licensee

Radio Band

AM

FM

Address Address 2 (optional) City State Zip Phone Fax

URLs

URL 1 URL 2 (optional) URL 3 (optional) URL 4 (optional) URL 5 (optional) URL 6 (optional)

Contact Information

Primary Contact Name Primary Contact E-mail address Primary Contact E-mail address (confirm) Secondary Contact Name

Must be station management

Secondary Contact E-mail address

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