Viva Magazine : Survey

Thank you for your interest in The Face of Chile in Australia Cover Model Search contest. Please complete the following form. If you have any questions, please feel free to contact us.
If you prefer, you can print this page and send to us by snail mail to : VIVA MAGAZINE - PO Box 365 Petersham NSW 2049

We assure you the information from this survey will be kept strictly confidential! Viva Magazine passes no email addresses or details to any other organisation

PERSONAL INFORMATION
Title:
First Name: *		Last Name: *
Address:
City:		State:
Post Code:	Country:
Telephone: *
Email Address: *		Website:

STATISTICS
Date of Birth		Palce of Birth
Height
Dress Size		Shoe Size
Waist		Hip
Bust		Eye Colour

Hair Colour		Hair Lenght
Are you currently under contract with a modeling agency?		If so please list
Occupation		What Type of modeling have you done in the past?

I hereby affirm that I am over the age of 18 and have the right to contract in my own name.
I hereby affirm that I am a Chilean born person or with one of my parents born in Chile.
I have read and agree to be bound by The Face of Chile in Australia Cover Model Search Official Rules.

Full Name

Date

HOW DID YOU HEAR ABOUT LATINO EVENTS?

leaflets	media	word of mouth	SMS	email (Us)	email (Others)	please specify

ADDITIONAL COMMENTS & SUGGESTIONS