Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Are you over 21? *

Yes

No

Do you have a cell phone? *

Yes

No

Do you have a way to access your email account regularly? *

Yes

No

Do you have reliable transportation to get to work? *

Yes

No

Do you have TIPS or GUARD certification? *

Yes

No

Are you afraid to get on stage and “shake your tail feather”? *

Yes

No

Do you have any obligations on a Friday or Saturday in the next 6 months that will prevent you from working? *

Yes

No