| Interested in |  |
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| If you live in Canada, select your nearest major city |  |
Other city not listed |
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| United States, enter nearest major city | |
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| First Name |  |
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| Last Name |  |
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| PHONE NUMBER (at least one) | | |
| Home Phone | |
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| Cellular Phone | |
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| Work Phone | |
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| Other Phone | |
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| EMAIL (at least one) | | |
| Home Email | |
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| Work Email | |
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| HOME ADDRESS | | |
| Street | |
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| City: |  |
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| Province / State | |
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| Postal Code / Zip | |
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| Country |  |
other |
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| Website /Gallery 1 | |
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| Website /Gallery 2 | |
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| Facebook page | |
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| Experience | |
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| Education: we are very interested in knowing about your photography or art degrees, courses or training | |
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Your equipment:
camera body, backup camera body, lenses (indicate whether Canon, Nikon, etc), backdrop, lighting | |
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| Do you have a studio (for occasional individual headshots)? | |
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| Own laptop computer? | |
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| Languages spoken: | |
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| Own or have access to car? | |
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| Have Liability Insurance? | |
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| Accredited by | |
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| Other comments or information that we should know about you? | |
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| Attach resume, profile or your photo.(optional) | |
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