MODEL APPLICATION / RELEASE FORM

This application is intended only to obtain information necessary for your placement in the
proper modeling assignments. This application is confidential and no information will be
released without your authorization. Please answer all questions as completely as possible.
While this application is not a guarantee, your answers will help us in answering questions
on your modeling intends that will best suited for you.

LEGAL Name:______________________________________________________________________
(First, Middle, Last)
ALSO KNOWN AS: ___________________________________________________
ADDRESS: ____________________________________________APARTMENT NUMBER: ________
CITY: ______________________________ STATE: ______________ ZIP: _________________
HOME PHONE: (____) __________________ CELL : (_____) ____________________
E-MAIL: ________________________________________________________
WEB SITE: _______________________________________________________________________
SSN/NATIONAL ID CARD NUMBER: ___________________DOB: _______ /_______ /_________ AGE:
__________
STATUS: MARRIED ( ) SINGLE ( ) DIVORCED ( )
NATIONALITY/RACE: ___________________________
HEIGHT:_______ WEIGHT:_______ BUST:_______ WAIST:_______ HIPS:_______
SKIN COLOR: LIGHT ( ) MEDIUM ( ) OLIVE ( ) BROWN ( ) BLACK ( )
EYE COLOR: _____________ HAIR COLOR: _____________ HAIR STYLE: ______________
CLOTHING SIZES: DRESS ______ BLOUSE ______ PANTS ______ SHOES ______
SCARS/BLEMISHES/TATOOS OR ANY OTHER IDENTIFYING MARKS:
________________________________________________________________________________
________________________________________________________________________________
ARE YOU CURRENTLY EMPLOYED: YES ( ) NO ( ) IF YES, WHAT ARE
YOUR DAYS AND HOURS: __________________________ OCCUPATION ____________________
DO YOU HAVE TRANSPORTATION? YES ( ) NO ( )
HOW FAR WILL YOU TRAVEL (ONE WAY) IN ORDER TO MODEL: _____________
HOBBIES AND INTERESTS: __________________________________________________________
_________________________________________________________________________________
MODELING EXPERIENCE:
NONE ( ) BEGINNER ( ) INTERMEDIATE ( ) ADVANCED ( ) PROFESSIONAL ( )
(List OF Magazines, film, events, etc) _________________________________________
_________________________________________________________________________________
Continued on back
Please indicate the following types of modeling assignments you would be willing to accept
by checking the appropriate box.

YES MAYBE NO TYPES OF MODELING: YES MAYBE NO TYPES OF MODELING:

(X ) ( ) ( ) FASHION WEAR ( ) (X ) ( ) RUNWAY
( X) ( ) ( ) CAUSAL WEAR ( X ) ( ) ( ) SPORT/FITNESS WEAR
( ) (X ) ( ) SWIMWEAR ( ) ( ) ( X) LINGERIE
( ) (X) ( ) WET T-SHIRT/SEE-THRU CLOTHING ( ) ( ) ( X) SEMINUDES
(Topless)
( ) ( ) ( X ) NUDE (PLAYBOY STYLE GLAMOUR) ( ) ( ) (X) EROTIC NUDES
( ) ( ) ( X) ARTISTIC/FIGURE NUDES ( X) ( ) ( ) MAGAZINE WORK Layout
w/Release
( ) (X) ( ) PARTS MODELING ( ) (X) ( ) PRINT

NOTE: Please bring a snapshot of yourself when you return this application.
COMPENSATION EXPECTED: ( ) NEGOTIABLE ( ) PHOTOS ( ) PAY ( ) BOTH

I certify that the information is true and correct to the best of my knowledge.
MODEL’S Signature __________________________________ Date ____________
Model/Photo Release
I, ________________________________________ (Model), Do hereby give Brijuni the irrevocable
right to use the photograph(s) of ____________________________________ (Model) for self-
promotion, sale, advertisement, competition, representation, or display in print and/or
electronic media. I understand that by giving permission to Brijuni, I do hereby relinquish all
rights to the photograph(s). Copyright and ownership belongs to Brijuni to publish or utilize
the photograph(s) as they see fit.

(Model)
Signature: _____________________________________ Date: ______________

Signature: _____________________________________ Date: ______________ for Brijuni

(Note: Model must provide a photo copy of valid government-issued photo identification card
with this release form).