Media Five Entertainment

If your band is interested in working with Media Five Entertainment, fill out the following application. This form is to benefit both you and Media Five Entertainment by providing us with a deeper understanding of what you, your artist, or your band has to offer. By filling out this form, we can better determine how to help you. If you would like to submit a bio, CD, DVD, video or other promotional materials, after submitting the following application, please mail your promotional materials to:

Media Five Entertainment
Attn: Band Submissions
3005 Brodhead Road Suite 170
Bethlehem, PA 18020

After we have had a chance to review your material, someone will contact you. Please be advised that this process may take some time.

Before you begin filling out these forms, please ensure you have general information available for your artist or group, as well as information for each band member, if applicable. Fields with an asterix(*) are required, although we strongly suggest filling this form out as completely as possible.

Use the tab key to jump between fields.

* band/artist name:

* # in band:
* style:
website:
* contact name:
	band leader/member manager
age:
* street address:
* city:
* state:
home:
work:
cell:
fax:
* e-mail:
SS# or TAX ID#:	TAXID SS
If you are a manager representing an artist or band, you may skip the next two questions.
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
does the band/artist own
a P.A.?	yes no
lights?	yes no
truck?	yes no
does the band/artist travel with
a sound person?	yes no
a lights person?	yes no
current set list:

list current bookings (venue, city, date):

work as musicians:	fulltime parttime
how many days a week would you work?
how far will you travel?
amount of time performing:
days of week you rehearse:
list any agents you work with:

Do you have any live/studio recordings on CD, DVD or VHS you can send us? yes no
Please list any advertising mediums you use and how often, including the names of any daily, weekly or monthly newspapers and/or radio stations.

If you maintain e-mail and/or snail mail lists, how many subscribers do you have?
e-mail addresses:
mail addresses:
What are your short term goals?

What are your long term goals?

Do you have any publicity shots or posters?	yes no
If so please send them along with your submission.

if you are a solo artist and are acting as your own manager, you may submit this application now. Otherwise, scroll down to add another musician until you have provided info for all members. When you have added all the members, scroll to the bottom of this page and click submit.


MEMBER ONE
name:
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
age:
street:
city:
state:
home:
work:
cell:
fax:
e-mail:


MEMBER TWO
name:
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
age:
street:
city:
state:
home:
work:
cell:
fax:
e-mail:


MEMBER THREE
name:
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
age:
street:
city:
state:
home:
work:
cell:
fax:
e-mail:


MEMBER FOUR
name:
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
age:
street:
city:
state:
home:
work:
cell:
fax:
e-mail:


MEMBER FIVE
name:
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
age:
street:
city:
state:
home:
work:
cell:
fax:
e-mail:


MEMBER SIX
name:
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
age:
street:
city:
state:
home:
work:
cell:
fax:
e-mail:


MEMBER SEVEN
name:
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
age:
street:
city:
state:
home:
work:
cell:
fax:
e-mail:


MEMBER EIGHT
name:
vocalist:	none lead background
please list any instruments you play. If you do not play an instrument leave these blank.
instrument 1:
instrument 2:
instrument 3:
instrument 4:
age:
street:
city:
state:
home:
work:
cell:
fax:
e-mail: