Senior Model Application

Name:
Email Address:
Parent's Names
Phone #
Alt. Phone #
Address
City
State
Zip
Graduation year
School
Current extra curricular activities
Have you seen our work before?	Yes No
How did you hear about our Senior Model Program?
Tell us a little bit about you.
What would make you a good Senior Model?
Check all that you are a member of:	MySpace Facebook Blogger Friendster Other
Would you like to receive announcements for specials & discounts on our products and services?	Yes No
You will need to email us your most current photo to inhiseyes@speednetllc.com. You may want to write that down now. Do you have a current photo of yourself?	Yes No I will send it within 3 days.

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