Mix FM

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Email Address

First Name

Last Name

Gender

Female

Male

Birth Date

- - (Use 4 digits for the year)

Race

I/C Number

Area

Mobile phone number

Other contact no

In an average week, how much time do you spend listening to the radio?

Fewer than five hours per week
Five to 10 hours per week
More than 10 hours per week

Which of these stations have you listened to in the past week? (select all that apply):

Mix FM
Hitz.FM
Lite FM
Fly FM
Sinar FM
HOT FM
Era
My FM
988

Which of these stations is your overall favourite for music, the one you listen to most when you control the radio?

Mix FM
Hitz.FM
Lite FM
Fly FM
Sinar FM
HOT FM
Era
My FM
988

How often do you send/receive email? (personal and/or business):

More than once per day
Once per day
A few times per week
Once per week
A few times per month
Once per month

How often do you surf the web?

More than once per day
Once per day
A few times per week
Once per week
A few times per month
Once per month

Comments about Mix FM:

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Invitations to participate in online music surveys.
Exclusive information about free concert tickets, movie passes, and other cool stuff!

The contact information you submit is confidential. It will only be used for Mix FM and will not be provided to any other party. You may remove yourself at anytime. Members must be at least 13 years old. Members are also required to provide truthful information. We will reject duplicate entries or any entry that we discover to be false or fraudulent.