Indie Music Channel Awards

to be held at

Hang On to the Dream Theatre

Registration:

$150 per person

*participants under 18 are allowed one complimentary Summit pass for a parent

Daytime/Cell Phone: *

City: *

Zip/Postal Code: *

Address: *

State: *

Please complete the registration form below:

Artist or Band's Name: *

Email: *

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Country: *

Electronic Signature: *

Submitter's Name: *

Are you a member of the Indie Music Channel? *

Yes

Indie Music Channel Artist Page address:

Registration Form for the