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Name:

Company Name:

Website Address:

E-mail Address:

Phone Number:

Type of Assignment: Select One Print (Magazines, Calendars etc) Tradeshow/Public Appearances Acting (Commercial, Video, Film etc) Runway/Fashion Shows Ring Card Girl

Date or dates of the assignment:

Estimated rate per 8hr. day (if less than 8hr. day then hourly rate):

Is the assignment in the So. Ca. area? Yes No

If travel is involved, to where?

Please provide details about the assignment and what you expect of me: