Confidential Model Interview Form

***Fields in red are required.***

Full Name:

Email Address:

Website Address:

Street Address:

City:

 State:

Postal Code:

     Country (if non-USA)

Phone Number:

  *include area code

Alternate Phone:

Please contact me about:

 Free Interview  Photo Session   Internet Specials

Please contact me by:

 Phone   Email   Postal Mail

Nationality:

Are you willing to travel?

No Yes

Do you have a passport?

No Yes

Date of Birth:

Ethnic Descent:

Languages Spoken:

Height:

Weight:

Natural Hair Color:

   Length:

Eye Color:

Bust:

   Cup Size:

Waist:

Hips:

Level of Experience:

Novice Amateur Semi-professional Professional

Areas of Interest:
(Check all that apply)

 Print   Commercial  Fashion   Photography   Television

 Film  Magazine  Art   Glamour   Lingerie  Nude

 Semi-Nude   Topless   See-through   Other

Are you presently bound by any type of contract or agreement with an agency, agent, corporation, manager, employer or photographer? Yes     No

Special Talents:

 Singing   Dancing   Acting

 Musical Instrument  Modeling  Other

Complete this sentence: "I've always wanted to be a...

Which magazine have you always wanted to be in?

Optional headshot: You will be given the opportunity to upload your photo in the next step.