BROADCAST SYNDICATION QUESTIONAIRE

Please submit this form in conjunction with paying your Initial Consultation Fee

If your show airs on a local station, consult with your station Manager or Engineer for any information you do not know, or leave those questions blank. This information is NOT critical to completion of this form. Only items in red must be completed.

Just to make sure there are no mistakes, and we can associate your application with your payment, please enter
Your real name again, please:

and your E-mail address again:

HOST NAME:

EMAIL:

PERSON RESPONSIBLE FOR MANAGEMENT / FINANCIAL MATTERS RELATED TO THE SHOW (IF DIFFERENT FROM HOST):

EMAIL:

CO-HOST NAME (if any):

EMAIL:

PRODUCERS NAME (if any):

EMAIL:

PROGRAM NAME:

ADDRESS:
City, State:
Zip:

PHONE for principal contact for show:

SHOW CURRENTLY AIRING:
Call Letters:
AM
FM
Commercial
Noncommercial

MARKET SERVED (or claimed):

CITY OF LICENSE:

TRANSMITTER POWER:
IF AM, DIRECTIONAL OR NON-DIRECTIONAL
Directional
NonDirectional

IS THE SHOW BROKERED (are you paying for your air time?)
Yes
No

IF SO, HOURLY RATE: $

Hours Per Show:
Time Slot:
Day:
Number of days show airs per week:

NATURE OF SHOW:
Talk
Music
Variety
Documentary
Other

Explain:

GOALS OF SHOW:

TYPICAL TOPICS:

TYPICAL GUESTS (IF ANY):

TYPICAL MUSIC SELECTIONS (IF ANY):

HOW LONG HAS THE SHOW BEEN ON THE AIR?

DESCRIBE ANY OTHER EFFORTS MADE TO PUBLICIZE THE SHOW BY YOURSELF, THE STATION OR OTHERS & LEVEL OF SUCCESS:

WHAT CRITERIA WILL YOU USE TO DETERMINE THE FUTURE SUCCESS OF THE SHOW?

WHY DO YOU DO THE SHOW?

HOW YOU FOUND BRC PRODUCTIONS:
INTERNET / SEARCH ENGINE? WHICH ONE?
PROFESSIONAL REFERRAL? CARE TO IDENTIFY HIM OR HER?

ADDITIONAL COMMENTS OR QUESTIONS: