89.1 Max FM x My Chemical Romance – Entry Form Thanks for texting in to a Max FM contest! Please fill out the required fields below in order to complete your entry into the contest. If you have any questions, please contact us. First Name *Last Name *Email Address *Phone *MUST be the phone number you texted in your vote from!City/Town/Municipality *Date of BirthMonthDayYear(optional - this helps us learn who our listeners are!)GenderMaleFemaleOtherPrefer not to say(optional - this helps us learn who our listeners are!)What was the chemical of the hour that you heard on the radio? *I want to join the Max Minority! I consent to future promotional communications from 89.1 Max FM by e-mail or phone, with the understanding that I can choose to opt out at any time.Yes(optional)Enter Contest
