|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Have you ever been affiliated or recieved coverage in printed media local or national?
|
|
If so, what publication
|
|
What are your current individual or business goals for the next 5 years:
|
|
Do you have a professional resume?
|
|
| List career accomplishments below |
|
Web site or Social Networking Site:
|
|
Are you able to travel?
|
Do you have a professional portfolio, photos, or bio available to be considered for print:
|
|
| Image/Information Liability Release |
I hereby give Dance Mogul Magazine and its affiliates the absolute right and permission to publish, copyright and use pictures, videos and all other types of media, of me or my business in which I may be included in whole or in part, composite or retouched, in conjunction with my name and/or professional information. I do hereby release Dance Mogul Magazine and their staff and agents from any and all liability as a result of my participation. Dance Mogul Magazine reserves the right to end, cancel, deny and/or refuse my participation at any time for any reason. I understand that by signing this document, I agree that I have read this Image and Information Liability release statement, fully understand it, freely and voluntarily sign it, and I am acting for myself, my heirs, personal representatives, and assigns.
*I agree to the Image/Information and Liability release statement above. |
Signature:
Date:
|
|
Check all that apply:
|
|
Name of minor:
|
|
| All information is confidential and will not be shared or traded. |
|
|
