Hip Hop Idol

PLEASE COMPLETE THE ONLINE FORM BELOW

- OR -

REQUEST A REGISTRANT FORM AT INFO@HIPHOPIDOLTV.COM

Name of Lead:

Birth date:

List any additional names in group along with their birth dates below:

Group Name:

Tag line for group or individual:

Address for Lead:

Phone number for lead:

Alternate phone number #1:

Alternate phone number #2:

E-mail address for lead or group:

PAYMENT

$9.99 online registration fee. Groups are $9.99 per individual. $49.99 Offline registration fee. Release form must be checked. (Be advised, Date and location may change, be prepared to switch audition date)

Total amount of payment:
($9.99 online registration fee. Groups are $9.99 per individual.)

Credit Card Number:

Name as it appears on credit card:

Type Card: (check one) Visa MasterCard

Expiration Date: Month Year

CVV2# What's This?

Card Holder’s Signature

Card Holder Address:

Street:

City:

State:

Postal/Zip Code:

Phone:

Email: