Station Call Letters:

Date:

Station Name:

Street address:

City, State, Zip Code:

Telephone Number:

GM/Owner Name:

Email Address:

Website URL:

(Check each box to agree with the statement)

 I hereby certify the station named above to be of the “Christian Radio” format (music or talk).

We have a Personal Computer that can be used exclusively for internet broadcasting.

We have or will have a DSL, ISDN, T-1, or Broadband Internet Connection.

We have or will download the free Microsoft Media Encoder software

We have or will read the BRM Implementation Guide.

We have read, signed, and submitted the electronic version of the BRM Use & Practices Agreement.

We have attached a check for $50.00 which represents the stations first month Network Access Fee