Become an Affiliate Form

First Name

Last Name

Title and Position

Station Email

Station Name / Call Letters

Address Street City State Postal Code Country

Is Shipping Address the same as Mailing Address? Yes No

Phone Number

Station Email

Station Website

Imaging Liner

Radio Type

Frequency / Band

Power (ERP)

Directional or Non-Directional?

Antenna Height

Licensee

City of License

City of License Population

License Type

Repeater Stations / Translator

Talk Programming/Music Mix Ratio

Primary Format

Music Format

Other

Current Audio Network News Source

What Moody Radio programming are you interested in via satellite?

Why are you interested in Moody Radio service for your station?

Is your station's management in agreement with Moody's Doctrinal Statement?

Yes No

When would you like to begin airing Moody Radio programming? :

Would you like to subscribe to our monthly e-mail communication, letting you know of important programming changes and upcoming specials? Yes No

Preferred Email