*E-mail Address:

*First Name:

*Last Name:

*User Name:

*Password:

*Re-enter Password:

*Address:

*City:

*State: FL GA

*Zip Code:  32608 32607 32605 32606 32601 34472 32669 34471 32609 32603 32615 32667 32696 34482 32619 34480 34488 32653 32693 34420 34470 34474 34476 34479 32618 32640 32641 32643 32686 34491 32113 32134 32617 32625 32668 34432 34475 32179 32611 32621 32626 34431 34473 34481 32195 32631 32694 34449

*Gender: Male Female

Birth Month: 1 2 3 4 5 6 7 8 9 10 11 12 Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year:

*Age: 16 - 17 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+

Work Phone:

Home Phone:

Please answer the questions below:

1. What is your marital status? Single Married Divorced

2. Are you a student? yes no

3. How many hours a day do you listen to Rock 104? none 1 - 2 3 - 5 6 - 8 9 - 12 12+

4. What shows do you listen to?(Check all that apply)

Lex & Terry in the Morning The Lunchtime Block The Work Release Program Mandatory Metallica All Request Free-For-ALL Breaking & Entering Locals Only

5. Where do you listen to Rock 104?(Check all that apply)

Work Home Car

6. What do you do in your free time?(Check all that apply)

Go to movies Go to concerts Shop Health/fitness Cultural events Watch TV Surf the Internet Read newspapers/magazines Attend sporting events Dine Out Other

7. If you work, what do you do? Management Sales/Marketing/Retail/Service Computers/Internet Medical or Legal Goverment/Education Secretarial/Administrative Manufacturing/Construction

Other:

8. Which of the following events did you attend in the past year?(Check all that apply)

Gator football or basketball Rock 104's Locals Only Concert Series Saturday Night Rock Solid Showcase Any charity event UF homecoming events, including Gator Growl