Appointment Request:

If you would like to setup an appointment with me, please fill out the form below.

IMPORTANT NOTICE: All information is strictly confidential and will not be given, shared or disclosed to any third party.


General Information:
First Name:
Last Name:
Phone Number:
City:
State:
E-Mail Address:
TER Handle:

Screening / References:
Employer / Company
Job Title
Work Phone:
Please provide three references of models you have worked with recently. You might consider giving them a courtesy call/email that we will be contacting them for a reference.
NOTE: Not required if you have a TER handle with references.
Reference #1 Name
Phone
E-Mail Or Website
Reference #2 Name
Phone
E-Mail Or Website
Reference #3 Name
Phone
E-Mail Or Website

Appointment Information:
Month:
Day:
Time:
Appointment Length:
Location:
Comments:
You can provide any additional comments or information here.

How Did You Find Me?
TER Website
CityVibe Website
Other (Please Specify)
Personal referral, search engine, etc.

After pressing the 'Submit" button you will see a confirmation screen that indicates
your information was successfully sent.  I will review your information and
contact you within 24 hours.  Thank you!

 

 

 

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