Thank you for your interest. Please complete this form and click on the "send" button located at the bottom. Please make sure that all of the fields are appropriately filled out, checking for typographical errors and incorrect information.
 
Fields preceded by  * must be filled out to ensure proper processing of this form.
This form will be sent via your e-mail.

 
First Name*           Last Name* 
           Title*     Business Name*
    Address*    City*   
 State/Province*    Country*    ZIP/Postal Code*
Phone Number    Fax Number   
(enter numbers only; include area code)
        E-mail Address*   
        Website Address   
Please briefly describe your business/facility.*

Indicate the category that best describes your job function below. 
Select ALL that apply : *

  Film/Video Producer
  Music Producer 
  Film/Video Director
  Technical Management and Engineering (including: Post-Production 
       Supervisor, Film/Video Editor, Audio Engineer, Sound Designer, 
       Special  Effects Supervisor, Technical Director) 
  Corporate/Company Operations Management (including: Owner, 
       President, General Manager, Operations Manager, Marketing Director, 
       Corporate Executive)
  Talent Agent
  A&R Director/Representative
 Please list the city and state/province where 
your business is originally registered : * 

City*    State/Province* 
How did you find the Dark Tower Online website? 

Please select your FREE promo albums and/or Promo Packs below : * 

  Dark Tower Promo Pack
  Plutonian Shore Promo Pack 
  The Dream Gallery - Dark Tower Special Edition Promo
  Skindeep
  Destiny Hunt
  Waterborne
  Relics
  Ignis Fatui
  Compilation Disc
  Scarecrow's Dream - Original Motion Picture Score & Additional Tracks