Music Gorilla - Industry Rep Registration

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	Your Membership is 100% FREE if None of Your Music Gets Heard by the Industry!

To Sign on to MusicGorilla.com:

Please fill out this form as completely as possible, and fax or submit it via the Internet. Failure to answer can result in your membership being delayed. If you need assistance or have questions, please e-mail industry customer at industry@musicgorilla.com. You will be notified within 24 hours when your membership has been approved and posted. Thank you!

Voice: (512) 918-8978
Fax: (512) 258-6394



	ALL CONTACT INFORMATION WILL BE KEPT CONFIDENTIAL
	*Screen name:	(Do not use &, !, /, \ characters)

	*First name:

	*Last name:

	*Email address:

	*Password:	(must be at least 6 characters)

	*Confirm password:	(password is case sensitive)

	*City:

	*Country:

	*State:

	*Zip code:

	*Company:

	*Company Address:

	*Company Phone (for verification purposes):	-

	Company Fax:

	*Position:	Other:

	*Birthday:

	*Male or female:	MaleFemale

	*Genres:	Alternative Americana Blues Christian/Gospel Country Dance Electronic Folk Funk/Fusion Heavy Metal Instrumental/Soundtrack Jazz Latin Pop Punk Rap/Hip-Hop Reggae Rock Singer/Songwriter Soul/R&B World

	*How many songs will you listen to weekly on average:

	*Can we use your:

	*Preferred Method of Contact:

	Cooperative Agreement

	Next step

	Thank you for your request. Your new account information will NOT go live immediately! It will take our staff 24 hours to review the information. You will be notified by e-mail when your request has been fully processed. Back to the main page