EmailMe Form - WRITE UP! 6-MONTH PROGRAM

Name *

First Last

Email *

Phone Number *

### - ### - ####

Website (If Applicable)

Address (Billing) *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Tell us a little about yourself as a writer. Please let us know what your strengths and weaknesses are, and what you hope to take away from this experience. *

Do you play an instrument? *

If Yes, please describe:

Which would you say best describes your writing strength? *

Melody

Lyric

Both

Are you comfortable co-writing? *

Payment Information

Once submitted, your card will be charged in the amount of $2750 USD and is non-refundable.

Card Type *

Card Number *

Exp. Date *

MMYY

Security Code *

3 digit code located on back of credit card. For Amex users, this is the four digit code on the front of the card.

Your Music

Please give us THREE examples of your best songs. We do NOT accept MP3's by email, so you will need to provide a streaming link to your song so that we can listen. If you don't currently have your songs streaming online, you can utilize websites like http://www.vibestreamer.com/ to do so. Then simply copy and paste your lyrics in the lyric boxes and we will get the information to your mentor.

Song Title 1 *

Link: *

Song Title 2 *

Link: *

Song Title 3 *

Link: *