-- USER INFORMATION -- username: password: (will be encoded) first name: last name: your e-mail address: mailing address: mailing address (line 2): city: state: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming country: UNITED STATES CANADA MEXICO UNITED KINGDOM zip: date of birth (MM/DD/YEAR): phone (optional): school name (if applicable): campus newspaper name (if applicable): Are you in a fraternity/sorority? Yes No Are you involved in music? (please specify below) In a band? Yes No In a music program? Yes No Work at a record store? Yes No Work at a music venue? Yes No Work for a radio station? Yes No Other (please explain) Please list the cities where you would like to promote: Please list specific places where you would like to promote (i.e. nearby venue names, store names, etc): Do you have access to a car? Yes No How would you like to promote? Online (message boards, etc.) On the street (hang posters/flyers, etc.) Both Please list any other ways you feel you can help promote ZOX: Upload your picture (160 x 160 please):       © 2004. All Rights Reserved.	Username: Password:     Andy Winkler New York, NY