CRN Affilate Application Form -

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Radio Station Call Letters *

Enter your station call letters & nickname (if any)

Market Rank

Nielsen or Arbitron Market Number

How did you hear about The Mike Church Show

Frequency & Band (AM/FM) *

Enter your station frequency e.g. 1010AM, 97.9FM

Address

Address Line 1

Address Line 2

City

State

Zip Code

Your Name *

First

Last

Your Position At The Radio Staion

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Email Address *

Business Phone Number *

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Primary Website/Blog URL: *

Average Monthly Website Traffic *

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Why do you want to become a Mike Church Show affiliate station? *

Please list other syndicated shows your station broadcasts *

How do you promote your station's shows? *

List any promotions you do internally (on0air_ for the syndicatd shows on your station

If you're ready you can also fill it out!

Have you read and understood our Affiliate Program Terms & Conditions? *

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