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( Thee Official Moonkloud Independent Records Fan Club Sign Up Sheet )

Name

Sex

M F

Age

Occupation

Job Title

Homepage Link

Title of Homepage

Where you from ?

How did you find us ?

Education

High School
Junior College
College
Graduate School
G.E.D

Favorite kinds of music ( Pick as many as you like ).

Pop & Soul
Hip - Hop, Rap
Electronica
Gothic
Industrial
Ambient
Dance
Acid Jazz
Oldies
Blues
Country
Folk
Gospel
Vocals ( Pop )
Sound Track
Jazz
Latin
New Age
Reggae
World Music
Classical
Rock, Shock Rock, Heavy Metal & Alternative

Other

Number of records purchased last year.

1-5

6-10

10+

Favorite Magazine(s):

Favorite Web Site(s):

Mail Address

Fax

Phone

e-mail

Comments

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