EmailMe Form - Central Illinois Model Showcase

Name
First Last
Email
cell phone
This is for the editor to follow up with questions.
Below is information for the Central Illinois Model Showcase eMagazine
Indicate the selection that apply to you.
Model
Photographer
Designer
Other
Name to appear in Magazine
Indicate how you want your name to be listed in the Magazine?
Your Profile

(provide a brief write up about yourself that you would like to be included in the magazine about yourself.)
Photo #1
Provide a photo that you would like to include in magazine
Photo #2
Provide a photo that you would like to include in magazine
Link to online portfolio
Profile a link to an online portfolio or website.
contact or booking info to appear in the magazine.
What city do you currently reside?
If you don't have an online portfolio or website to include in the magazine would you be interested in having one setup?
Yes
No
Not Sure