On-Air Personality Data Form

Name (First & Last) *

Today's Date *

Email *

Phone Number *

Your "On-Air" Name *

Your Show Name *

CIty & State You Are From *

Social Media You Will Us On Air? (List platform and user name) *

Additional Social Media You Will Use On Air (List platform and user name)

If you have a podcast, please provide us the embed code.

Please write or copy and paste a bio for your website page. Please make longer than 200 words. *

Other information you would like on your bio page

Telegram user name *

Please submit 4-6 photos of yourself for the website and social media. Please make sure they are only of you. Photos of you with artists or bands accepted as well.

Photo 1 *

Photo 2 *

Photo 3 *

Photo 4 *

Photo 5

Photo 6