reality tv show

JEWELFORJIM ENTRY FORM

* means required.

Application Date:
First name*: Middle: Last name*:
Address:
City: State:
Zip code:
Email*: Cell Phone:
Home Phone: Fax No:
Age:
Eye color: Hair color:
Height: Weight:
Do you possess a valid ID:
How did you hear about this show:
Employment: Occupation:
Education level: Highest degree:
Where did you grow up?:
Marriage status:
Number of children:
Have you performed before?
Ideal Mate:
In a Relationship: Hobby:
A Unique talent:
Adjectives to describe you:
Accomplishments:
Any Tatoos:
Photograph (jpg or gif):
Do you have a Video profile:
Link to your Online Video profile:
Acknowledgement: This application and any other material
submitted by me, including, but not limited to pictures,films and DVDs
become the property of JumahStudio Inc.and AVF-Africa and shall not
be returned to the applicant.

I acknowledge that I have read and fulfill the eligibility requirements.
All the information and materials provided on this form are true and accurate
to the best of my knowledge.

I Agree with these conditions*:
Initials/Signature: