Registration - Great Lakes FM 101.5

Username *
Username
Password *
Password
Membership Level *
Basic Account
Email *
Email
Title *
Mr
Mrs
Miss
Ms
First Name *
Last Name *
Primary Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Postal Address
If different from above. Please enter the Street Number, Street, City/Town, Postcode and Country below.
Primary Phone *
Home or mobile
Work Phone
Work phone number, if any
Birthdate *
Occupation *
Would you like to volunteer? *
Yes
No
Skills or Interest
What skills or interests would you like to provide to the station?
Agreement for Members Only I do hereby make application to become a Member of Great Lakes Area FM Community Radio Association Incorporated and request you to enter my name on the Register of Members. If accepted, I certify I understand and abide by the Constitution and all other rules of the Association. I, the above named nominee, do fully understand that I cannot be elected as a Member of the Association until the Committee Management meeting following the expiration of fourteen days (14) from the date hereon.
Instructions Once you receive your welcome email and have activated your account please use the Login link to log into your account. From here you can submit your payment as a Member or Supporter.