Radio Input Form

This form allows you to provide users of the Info-Xone with information about your radio station. The InfoXone deals with a large number of enquiries every day, so it is in your interest to be accurate and to keep the information up-to-date.

Please provide the following contact information:

Name of Radio Station:
Owner:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal code:
Country:
Work Phone:
FAX:
E-mail:
URL:

Please indicate subject areas covered by your radio broadcasts (tick as many as are applicable):

International News	National News	Local News
Comedy	Drama	Financial Matters
Music - Classical	Music - Light	Music - Popular
Sport	Traffic	Women's Issues

Please indicate your primary target audience (tick as many as are applicable):

General Public	Women	Men
Social Classes A, B, C1	Social Classes C2, D & E
Age Group 15-24	Age Group 25-34	Age Group 35-44
Age Group 45-54	Age Group 55-64	Age Group 65 & over

What is the weekly reach of your radio station?
What is the average listening hours for your radio station?
What is the population of the area covered by your radio station?

List the names and job titles of the senior staff:
Any other information you would like included:
Any comments to help us:

For quality control and checking purposes, please give:
Name of respondent:
Job Title of Respondent:

Panarc International reserves the right to check, edit or reject any submission.

Last revised: November 15th, 1999