Please be sure to check our rates page before filling out this form.

Your Name
Your Email
Your Age
Your Race
Cell Phone No.
Have You Ever Used Our Service Before?		Yes No
If so do you recall when or who you saw and in what city?
	Star:
	City:
Approximate Date Last Used:

Which XXX Star would you like to see?

When?	at
How Long?
Where?
Name of City
Location Type
If out call, please specify	Other

Employer
Occupation
Business Phone	Ext.
Bus. Web
Contact via
Best time to call
Comments

Billing Information must be exactly as it appears on your card, or it will decline.
Pay Method
Card No.	CVC Code
Expire Date
First Name	Middle Initial
Last Name	Suffix (Jr., Sr. etc.)
Company Name	(If applicable)
Billing Address	(This address must be the address in which your credit card statement is mailed to. This must match exactly or it will be declined.)
Street (Line 1)
Street (Line 2)	(Apt./Suite # if applicable)
City
State	Zip
Country

You can e-mail your portfolio and/or pictures to officestaff@bodymiracle.com. It is imperative that your individual attachments and/or subject line include your stage name to ensure proper receipt with your application. (Individual emails should not exceed 15MB in overall size. Multiple emails are o.k.) Please make sure you have completed this form entirely before submitting. Incomplete forms will not be processed. Thank you. Thank you

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Revised: 1/10/2011