First Name:     Last Name:
Birth Date (MM/DD/YYYY)     

Street Address:

City:     State:     ZIP Code:
Country:

Home Phone:     Cell Phone:
AIM:

Primary E-Mail:

Secondary E-Mail:

Local Record Store(s):
Concert Venue(s):

How Many Hours a Week Do You Have To Do This?

Why Do You Want To Be On The XROXX Street Team?

Punk, Ska, Emo or a combo (and what is that combo)?

List Your Five Favorite Bands (Current or All-Time):

Anything Else You Want Us To Know?

I understand that I must be at least 13 years of age to submit this information. I further understand that XROXX can refuse me for any reason and is not required to respond why I was not selected. XROXX reserves the right to verify any information on this application. I understand that this position is an unpaid volunteer position. I understand that this agreement can be terminated at any time by either party for no reason. I understand that I am an independent, non-paid contractor of XROXX. I agree to abide by all local, state, federal and international laws. I agree not to hold XROXX liable should I get hurt while distributing XROXX materials as I am a non- paid, independent contractor. I agree to have fun while I'm distributing items for XROXX. I agree not to sell any items that I am given to free of charge from XROXX.