Entry Form - Q Country 96.1 - Hit Music Channel

Community Hero Entry Form

*All fields are required.

Your First Name:

Your Last Name:

Your Email Address:

Your Phone Number:

Your Nominee's First Name:

Your Nominee's Last Name:

Your Nominee's Contact Info:

Why do you believe the nominee deserves to be recognized as the Community Hero of the Month?:

SPAM Protection:
Please check mark I'm not a robot in this box:

Privacy Notice

Your registration information is for the use of KORQ-FM only. We collect information in order to keep you informed of contests and events sponsored or promoted by KORQ-FM. KORQ-FM will not sell, rent or in any way distribute personal information supplied to us by you. The information you provide us stays with KORQ-FM only.

Community Hero Entry Form

Privacy Notice

Sponsors