
TALENT AGENCY
LICENSE # 0000204
Fill out the form and send it in with payment to reserve a seat in one of Mary
Lou's Workshops.
Mailing Address:
Mary Lou's Models
P.O. Box 5127
Navarre, Fl 32566
850-712-1885
Please fill out a form for each student that will be attending the workshop.
Studio location: 913 Gulf Breeze Pkwy, Gulf Breeze, Fl
Circle which class you are attending: BASIC
PRE-TEEN KIDS
Amount enclosed
(DO NOT SEND CASH):________________________
Name:
________________________________________________________________________________
Guardian (if student is under the age of
18)__________________________________________________
Address:_______________________________________________________________________________
City:__________________________________________________________________________________
State:___________________ Zip:_____________________ Phone:______________________________
Cell Phone:___________________________ Email:___________________________________________
Birth Date:_______________________ Height:__________________ Eye
Color:_________________
Sizes:_______________________ Hair
Color:____________________________
List some of your talents below: