Pirate FM

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First Name

Last Name

Email Address

Gender

Female

Male

Birth Date

- - (Use 4 digits for the year)

Postal Code

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):

Pirate FM / Real Music Variety
BBC Radio Cornwall
Plymouth Sound
BBC Radio 1
BBC Radio 2
BBC Radio 3
BBC Radio 4
5 Live
Classic FM
Other

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

Pirate FM / Real Music Variety
BBC Radio Cornwall
Plymouth Sound
BBC Radio 1
BBC Radio 2
BBC Radio 3
BBC Radio 4
5 Live
Classic FM
Other

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 Pirate FM:

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The contact information you submit is confidential. It will only be used for Pirate 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.