Briargate Media

Station Request Form

Sharathon Request Due Dates:

Month

Due Date

March 2010

— January 15, 2010

April

— February 19

May

— March 19

June/July/August 2010

— April 16

September

— July 17

October

— August 13

Month

Due Date

November

— September 17

December

— October 15

January 2011

— November 12

February 2011

— December 17

Please select the purpose of your form submission.
Purpose of this submission:

*For Sharathon liners and giveaways, please use the "Custom sharathon, anniversary, program liners request form."
Station Information
Call Letters / Station Name: *
Frequency Numbers: *
Station Slogan: *
Network Affiliation:
Listening Area / Market:
Contact Information
Station Contact: *
Contact Title: *
E-mail Address: *
Street Address:
City:
State:
Zip / Postal Code:
Country:
Contact Phone Number: (include area or country code)*
Sharathon Information
Event Name / Theme:
Event Dates: *
Event Phone No (include country or area code):
Delivery Format:	CD - mailed MP3 file - e-mailed
Send Sharathon Promotional Items (no extra form needed if checked):	Send sharathon promotional items
Anniversary Information
First Broadcast Year:
Anniversary Number:	Your station's anniversary number.
First FOF Broadcast Year:	First year FOF was broadcast.
Radio Programming Information
Program	Radio Air Day(s) & Time(s)
Focus Daily:
Weekend magazine:
Adventures In Odyssey - Daily:
Adventures In Odyssey - Weekend:
Plugged In Movie Reviews - 1 Minute:
Plugged In Movie Reviews - 2 Minute:
Family News In Focus - 1 Minute:
Family News In Focus - 2 Minute:
Family News In Focus - 5 Minute:
FNIF Weekend:
FNIF Home Edition:
James Dobson Family Minute
Special Notes