W.G.U.P 107.9 FM Interest Form
"Leaders in the Neighborhood"
What type of advertising are you seeking to pursue?
Business Advertisement
Ministry Advertisement
Ministry Radio Broadcast
General Event Promotion
Client Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Phone Number
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please fill in the pertinent information regarding your business/ministry.
Organization Name
Organization's Principal Address
Point of Contact Name
Point of Contact Phone Number
Point of Contact Email
Please let us know a brief summary about your organization/ministry.
Please upload a logo for your business/ministry.
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Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
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