Perpetual Groove Street Team Sign Up

First Name:

Last Name:

Mailing/Shipping Address:

City:

State:

Zip:

Email:

Age

Birthday (xx/xx/xxxx)

Home Phone: (xxx-xxx-xxxx)

Cell Phone: (xxx-xxx-xxxx)

AOL IM:

Help us get to know you better.

1. Have you been on the PG street team before?

Yes	No

1a. Have you been on any other street teams?

Yes	No

1b. If yes, please list which ones:

2. What is your username on "Talking in Place" (the message board).

3. What is the closest major city you live near?

3a. Approximately how far is this city from where you live?

4. Do you own or have access to a Digital Camera?

Yes	No

5. Are you interested in helping with internet promotions?

Yes	No

6. How would you describe your knowledge of the internet (ie:HTML codes)

Very Good	Fair	What's the internet?

7. How many live concerts do you see a month?

8. Are you a student?

Yes	No

8a. If yes, please indicate the year:

8b. Name of School:

9. Would you be willing to pick up the promo at a specific meeting point in your town?

Yes	No

10. How much free time (hours) a week for you currently have to put into the street team promotions?

11. Is there anything else you want to tell us about yourself?