PERFORMER APPLICATION - Smiles

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you over the age of 18?

Primary Phone #: *

Email Address: *

Last 4 digits of your Social Security #: *

Stage Name: *

Body Measurements (Height, Weight, Hair & Eye Color):

Race/Ethnicity:

Emergency Contact Person + Their Phone #:

Initial with the acknowledgement of full nude performance per our establishment protocol: *

Initial with acknowledgment of performer social media presence (Twitter, Facebook, strip club list, Instagram, or any combination): *

Prior performance experience and/or history in the last 4 weeks:

Do you have a social media presence that represents your dancing career? If so, please provide links:

Do you have transportation to and from Smiles? *

What is your Availability?: *

How did you hear about Smiles?:

Do you have any medical conditions that would prevent you from performing at Smiles?: *

Affirmation of accuracy to the best of the performers knowledge (Type Full Name): *

Name will be counted as your signature affirming all above is true as of date of submission.

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