Radio Awards Order Form

City: *

Zip: *

Name to be inscribed on trophy (Example: John Smith) PLEASE SPELL CAREFULLY: *

State: *

Address: *

Indie Music Channel Page : *

What category did you win for: *

2nd Annual Radio Music Awards
Best Country Artist
John Smith
"Title of Song"

Artist or Band Name: *

Your Name: *

Daytime/Cell #: *

Country: *

2nd Annual Radio Music Awards Order Form

Congratulations on winning during the 2nd Annual Radio Music Awards!

If you are interested in ordering a trophy for your win, please complete the form below.

The trophy is an acrylic trophy that stands upright.

The main trophy inscription will read:

2nd Annual Radio Music Awards

Below that will be the category you won in, your name and the title of your winning song.

Example:

Email: *

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To order your award, please complete the form below.
The cost is $45, which includes engraving, shipping and handling in the US.
($70 Canada, $85 all other countries)

If you need a duplicate trophy for additional band members, producers,
sponsors, etc., please fill out a separate form.

To order your trophy, please complete the form below: