Exclusive Grooves.Com
DJ Pool New Member Registration

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  
Facebook/MySpace page *
AIM Screen Name / Service  
Computer type  
Affiliation/field  
(Check all that apply)  
Commercial Radio College Radio
Satellite Radio On-Air Personality (Radio)
Club DJ Record Label
Television/Film Clothing/Apparell
Production Promoter/Marketing
Video DJ  
How did you hear about us? *
If referred by a current pool member, please mention which dj.
 
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