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2. Contact Information
4. Talent's First Name*
5. Talent's Last Name*
7. Phone Number*
8. Email Address*
10. Age - We need talent of all ages!*

    Age

11. Gender
13. Parent/Guardian

    If the individual identified as the talent is under 18, are you the legal Parent/Guardian of the named talent?

15. Parent/Guardian Name

    If you are the Parent/Guardian, please provide your name.

17. Select all project types that interest you:

    1. Photo
    2. Video
    3. Voice Over
    4. Mascot
19. Experience

    No experience is necessary, but if you have experience you would like to share, provide details.

21. Please select the times when you are typically available.

    1. Days
    2. Evenings
    3. Weekends
    4. Weekdays
23. Headshot

    Please upload a photo of you or a headshot.

24. (Optional) Provide a video or portfolio link
26. 
    I agree to the following:
    
    

    By signing below, I understand that if my image is selected for projects, I give permission for the use of my image, voice and likeness to be used by the City of Rome and Georgia's Rome Office of Tourism and AdventHealth in various media formats for an unlimited amount of time and at no cost to the City of Rome, Georgia's Rome Office of Tourism and AdventHealth.

    I agree and hold harmless City of Rome and Georgia's Rome Office of Tourism and AdventHealth its employees, officers and agents from any liability associated with this grant, including without limitation any claims for libel or invasion of privacy. 

    
    

28. Date*
30. Signature*
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

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