localband.net - User Registration

If you have already submitted your information through the band or venue submittal process you do not need to send this form in unless you want weekly schedules or you would like to apply as an agent. Please check out our privacy policy before registering. *=Required fields =Required for Agents.
How did you hear about us?**	Details (if available)
First Name*
Last Name*
Username**
Password**
What is your primary locality?**
Address*
Address Line 2
City*
State*
Zip*
E-Mail**	You will be required to validate this email address before any of your votes will appear on the site. This is to ensure we can contact you and to prevent bogus voting and registrations.
Phone* (xxx-xxx-xxxx)
FAX (xxx-xxx-xxxx)
Primary Music Interest**
Other Music Interest
Do you have a cell phone with wireless internet access?	Yes No
Are you interested in being an agent?	Yes No
Do you want to be on our update list?	Yes No
Do you want weekly schedules sent to your e-mail?	Yes No
Comments (these are emailed only to localband.net, not any band or venue)