perRocKside - A Modern Rock Covers Band
perRocKside - Come and see the RocK Show!

perRocKside's Official Feedback Form ::

Please fill out the following information so that we can find out
exactly what rock songs you people out there wish to hear...

Make it YOUR RocK covers band!
Name ::
E-mail ::
Location ::

Do you have a song suggestion for us :: ?!?

Please check the adjacent box if you are making a request :: ::

Song Title ::
Artist / Band ::

** Please remember to mention the artist's / band's name
that performs the song you'd like to hear...

Public Response ::

Have you seen a perRocKside night? We'd like your opinion !



Which show did you see ??
e.g. Sun 19 Sep 04
Which venue did you see us @ ??
e.g. The Albion Hotel, Parramatta
Was the show visually entertaining ??
e.g. Stage presence, presentation, movement...		 :: Yes :: :: No ::
Did you enjoy the setlist ?? :: Yes :: :: No ::
Did we play enough variety of music ?? :: Yes :: :: No::
Please tell us about yourself - ** Optional

Your Gender :: :: Male :: :: Female :: :: Transgender ?? ::

Age :: Under 18 :: 18 - 25 :: 26 - 35 ::
36 - 45 :: 46 - 55 :: 55+ ::
Would you like to be included in our email list...?

Email List ?? :: Yes please! :: :: No thanks! ::

Your details will not be disclosed by us to any other Internet entity

Please share any messages, comments, opinions, or suggestions
you have for or about perRocKside's performance,
visual presentation or on improving the website...




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Do Not Use, Reproduce the perRockside banner or artworks Without Written Permission.
perRocKside Image © Adam Tait 2002 - 2004. All Rights Reserved.