Name: _____________________________
Address: ______________________________________
City: _________________ State:________ Zip Code: _______________
Phone Number:____________________________ Backup Number:________________________
Payment: Cash____ Check______ Money Order________
Please make payments payable to: iHeartMedia
Please complete this form and it (with check or money order) and send to:iHeartMedia of Florence, 181 E Evans Street, Suite 311, Florence, SC 20506
Note: Cash payments must be done in-person at the iHeartMedia Studios.
Download and print the registration form above. Complete it, and mail your $25 Entry Fee, check or money order to the iHeartMedia studios. You can also visit during normal business hours (Monday-Friday 8:30am-5:00pm) and submit your form and registration fee.
Thank you.
