Dazzle Model Mgmt. Registration Form

*Required Blanks

                                    Contact Information                                                                    Personal Information


*Talent Name
 		   *Age

*Address
 		   *Birth Date

*City
 		   *Gender

*State
 		   *Race (please
  be specific)

*Zip Code
 		   *Height

*Country
 		   *Weight

*Email
 		   *Hair Color

*Phone
 		   *Eye Color
Parent/Guardian
 if under age 18		   *Shirt Size
     
*Pants Size
 

Additional Information


*Any acting or modeling experience?
 

*Do you have a resume?
 

*Interested in Acting, Modeling, Singing,
voice-over, or all?
 

*How far are you willing to travel?  city/state
 

*Myspace URL or username (this is only to look at extra  photo's of you) - type none if you don't have one.
 

*Do you want a web page? 
**(See info below)
 

Short Bio
(this is only if you want a web page)
 

*Today's Date
 

Please unload your photo here. I need a headshot that is very clear and at least 50 kb's large. 
 


**I charge a one time fee of $20 for a web page.  This includes 5 additional photos, your resume
or bio, your own url, and all updating.  A WEB PAGE IS NOT MANDATORY!
I make these to make it easier for directors and agencies that visit my website.