Mary Lou's Models

Mary Lou’s Models, Inc.

TALENT AGENCY LICENSE # 0000204

P. O. Box 5127, Navarre, Fl 32566

Call; 850-862-1004 or 850-932-7330

Studio location: 913 Gulf Breeze Parkway, Gulf Breeze, Florida 32561

REGISTRATION FORM DATE: ________________

CLASS STARTING DATE: ________________________

CLASS NAME: ______________________________________________________________________________________

CLASS LOCATION: __________________________________________________________________________________

NAME:________________________ GUARDIAN:___________________________________________________________

ADDRESS:_________________________________________________________________________________________

CITY/STATE: __________________________ZIP:__________________________________________________________

PHONE NUMBERS (2)________________________E-MAIL:______________________________________

BIRTH DATE: _________________ COLOR: EYE__________HAIR_________________________________

HEIGHT:_________________________

SIZES: ________________________________SHOE:_______________________

Talents: ___________________________________________________________

RELEASE FOR PROMOTION OF YOUR IMAGE:

___________________________________________

Please send this form along with payment to:

Mary Lou’s Models, Inc.

P. O. box 5127

Navarre , Florida 32566

Serving the Gulf Coast Since1977