Application Request Form

If you are interested in receiving a membership application for Dixie Dance Kings, please complete the following form in its entirety. We will contact you by e-mail with instructions on next steps.

NOTE: Please be sure that you read and understand the requirements for membership as outlined on our membership page before completing this form.

Name (Not your DJ name)

DJ Name

Street Address

City

State

ZIP Code

E-mail Address

Daytime Phone

Fax Number (To receive an application by fax)

Which of the following DJ activities do you participate in?
Club DJ
Mobile DJ
Radio PD/MD/DJ
Radio Mixshow
If you do mixshows, please tell us the station name, call letters, and/or other details, including where the station is located (or if it's online). We also need a name and contact information for the station for verification.

If you have questions, comments, or special information you wish to convey, use the space below.