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: