Exxcel Model & Talent

Become a Model

Online Application - *Indicates a required field

GENERAL INFORMATION

First Name / M.I. / Last Name
*Today'sDate
Parent’s Full Name (if under 18 years)
*Street Address
City / State / *Zip
*Phone Number
Cell Phone
*Email

Height / Weight
Hair Color / Eye Color

Date of Birth / Age

List any previous modeling, acting, singing and/or dancing experience:

List any training in the modeling, acting, singing and/or dancing field:

List all agencies you are currently affiliated with:

Agency Name	Contact Person	Phone	Address	Signing Date

Do you have a portfolio/model’s book?	Yes No
Do you have an actor’s headshot?	Yes No
Do you have an actor’s reel/voice demo?	Yes No
Do you have a resume for:	Acting Singing Dancing Modeling

INDUSTRY EXPECTATIONS

I am interested in the following: (please check all that apply)
Fashion Modeling   Commercial Print   Acting   Singing   Dancing

Are you willing to travel?   Yes   No

At which level do you wish to be promoted?
Local   Regional   Metro   National   International

Do you have a current passport?   Yes   No

Have you ever modeled in a foreign country?   Yes   No

If Yes, describe:

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Corporate Office:
5500 Main Street
Suite 104
Buffalo, NY 14221

phone: 716.630.5010
fax: 716.630.5011
toll free: 1.716.630.5011