Roots Music Report - Radio Signup Now to Start Reporting to The #1 Independent, International Music Charts in the World

Reporting Station Application Form

Please fill out all information correctly. You may denied the ability to report if this information cannot be verified. This form is for radio to report to the Roots Music Report. If you are looking to sign up to access the RMR Database sign up here.

Contact Information

First Name:

Last Name:

Position at Station

Phone: (personal contact for support and verification)

Email Address: (please use a station address not personal if availible)

Re-Enter Email:

Station Information:

Callsign: (Call letters) - If syndicated show or internet use the shows name.

Frequency: - If syndicated show or internet, enter "Internet" or "Syndicated".

Format - Seperate With a Comma: (Genres Played - Blues, Rap, Country, etc.)

Web Site:

Station Phone: (for verification)

Station Address:

Address:

City:

Country:

We will issue you a username.

Password:

Re-type Password:

Comments:

By checking this box you agree to the User Terms and Conditions set forth by the Roots Music Report.

Please enter the above code: