Producer Signup

*RED items
are required		Private data
Name:  
Address 1:  
Address 2:  
City:  
State:  
Zip code:  
Email:  (this is your login username) 
Password:  
Re-enter password:  
Birthday: enter as MM/DD/YYYY  
Phone:  
 
Public data
Company name:  
Contact name:  
Bio:  
Email:  
Address 1:  
Address 2:  
City:  
State:  
Zip code:  
 Paste the entire url link including the http://
Official website:  
Myspace website:  
Facebook website:  
Twitter account:  
Youtube channel:  
Other website:  
I have read and agree to the Terms of Service  
 
 
Please upload a Promotional photo. Image may be resized as needed. Include any required copyrights on the photo!
Upload image:
 
Copyright text:  
Copyright url:  
 

By submitting this information, you will be allowing yourself to be listed as a producer on the Burlesque411.com website, with all the public information you've listed above. You also will allow Burlesqu411.com to contact you as needed for updates to site, and news.

Your private information will be not be shared or sold for any reason. Your public information will be posted live to the site.