Q-The Music Panel
Registration Form

Note: Federal law prevents your registration if you are under 13 years
of age. Thank you!

Simply fill in the blanks (all blanks are required) and you'll be registered to give us your opinions. It's that easy!

1 Please Select a Username (user name can only be one word)
Try to use something a little unique like your first and last name combined, your hobby, birthday, etc.

2 Please select a password

3 Your first name

4 Your last name

5 Enter your email address

6 What is your street address?

7 City

8 State

9 Your zip/postal code

10 Gender

11 Your birthdate

12 What is your marital status? (optional)

13 How many children are in your household?

14 Where do you listen to the radio MOST?
(please check only one)

15 Which of these radio stations have you listened to at least
once in past week? (select any/all that apply):

16 Which station did you listen to most in the past week? (choose only one):

17 How much time do you spend listening to the radio
in a typical day?

18 What/who is your favorite artist/band?

19 Who is your favorite Q-92 DJ?

20 What do you like to do in your spare time?
(check all that apply)

21 What is your annual income level? (optional)

22 What major purchases do you plan to make
in the next 6 months? (choose all that apply)

23 We just want to verify that you know you're signing up to
occasionally receive e-mail messages from us.
Note: All submitted information will remain confidential
and will not be used for any other purpose.