Station ID:

Genre:

Contact First Name :

Contact Last Name :

Email Address :

Position:

Street Address :

City: State:

Zip Code:

Country:

Phone Number :

1. Are you currently playing this cd on the air? If yes, which songs?:

(Check all that apply)
- 1. The Children
- 2. Stogie Blues
- 3. Dreamin
- 4. A Little Faith
- 5. Mary
- 6. My Friend
- 7. Another Life
- 8. Negative Boy

2. If you have not yet received a CD or would like an additional copy of the CD, "A Little Faith", how many copies would you like?:

0 1 2 3 4 5 6 7 8 9 10

If you are requesting more than 1 CD, who are the additional copies for?

- DJ's
- Program/Music Director
- Sister Station
- Giveaways

Additional Comments: