DJ Pool : Application for Membership

DJ Pool New Member Registration

Please make sure you are applying on the computer that you will be using to access our site. We will log your IP address, and you will only be able to log in if your IP address matches the IP address we have on file.

Also, if you're payment is coming from an email or account name that differs from the information on your application please let us know ASAP so we can apply your payment to the right account. This can be done by emailing us at info@exclusivegrooves.com.

DJ Name ^*

First Name ^*

Last Name ^*

Email Address ^*

Desired Password ^*

Re-enter Password ^*

Phone ^*
(XXX) XXX-XXXX

Age ^*
(numeric only)

Sex

Birth Date
(MM/DD/YYYY)

/ /

Payment Method ^*

Billing Address ^*

City ^*

Country ^*

State ^*

Zip/Postal Code ^*

2way / text pager

Web page

MySpace page ^*

AIM Screen Name / Service

Computer type

Affiliation/field
(Check all that apply)

How did you hear about us? ^*
If referred by a current pool member, please mention which dj.

I would like to receive emails regarding exclusivegrooves.com