Internet Music Rights for Public Broadcasters

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 (if applicable)

Address Address 2 (optional) City State Zip Phone Fax

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

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