Please enter the following information- Required fields are in bold type

Email address:    

Your Name:    

School and/or Organization:    

Street Address for T-Shirt:    

Town:     State: Zip:

Favorite Radio Stations: 

Favorite Kinds of Music: (check as many as you like)

Top40/Dance Rap Alternative Rock Techno/Trance Ambient

Favorite Artists:

Have you ever seen us in the past: Yes Once Yes Often No

If so, where?:   

What type of function was it?:     Dance Party Formal Wedding Anniversary Birthday Party Bar Mitzvah Bat Mitzvah Fund Raiser Corporate Event Other

On a Scale of 1-10 rate us with 10 being the best:     10 9 8 7 6 5 4 3 2 1

Does Your School Have Video Dances During The Year?:     Yes No

Would You Rather Have Club T's, All DVD, Video Dance Party?:      Yes No

Do You Have Any Comments Or Ideas That Would Help Improve Club T's Services?:

If You Would You Like To Have Club T Productions At Your Next School Dance Or Prom, Place Your Adviser's Name Here So We May Contact Him Or Her:

Do You Have Any Comments Or Ideas That Would Help Improve Club T's Web Site?:

Thanks for your input!