Activation Request Form

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* Indicates required question

Email *

Your email

Activation Representative Name *

Your answer

Activation Representative Cell Phone Number *

Your answer

Station Call Letters

Your answer

Name of Event *

Your answer

Activation Details *

Your answer

Station Special Requests / please select all that apply

Station requires power

Station is broadcasting live

Other:

A copy of your responses will be emailed to the address you provided.

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