2016 (10th Annual!) Fashion Show for All Abilities Model Application Form
Please Fill Out Completely – ONLY COMPLETED FORMS WILL BE ACCEPTED

Model Name:
Contact Information
Home Address (Photo CDs will be sent here): City: State: ZIP:
Phone number: Email Address:
Support Provider/Family Member: Agency:
Phone Number: Email Address:
Please indicate Primary Contact Person: □ Support Provider/Family Member □ Model
A valid email address is REQUIRED for the primary contact person – all correspondence is via email.
Model Information – if you are unsure, please estimate size/age/etc.
□ Male □ Female / Age / Top Size / Bottom Size / Height
Accommodations: □ Wheelchair □ Walker/Walking Sticks □ Visually Impaired □ None □ Other:
Do you desire assistance walking/wheeling down the runway? □ Yes □ No □ Unsure
Have you participated in a prior Fashion Show for All Abilities? □ Yes □ No
Style Preference (retailer match not guaranteed)
□ Casual □ Dressy □ Formal □ Sporty □ Mature □ Young
Mandatory Rehearsal
If you are selected to participate in the Fashion Show, you will need to attend one rehearsal. The rehearsal will take place at the Waisman Center Outreach office: 122 E. OLIN AVENUE, Ste. 100, Madison. Models will be notified of rehearsal dates/times in March.
Interests: Please list some activities/hobbies/an interesting fact about you, or what being in the fashion show means to you (to be read during the show as you walk down the runway):
□ Completed Audiovisual Release Agreement (attached).THIS EVENT IS OPEN TO THE PUBLIC.


Completion of this form is an application only; it does not guarantee entry into the Fashion Show for All Abilities.
All participants will be notified of model selection by email after the Call for Models is closed.
Individuals who have not previously modeled in the Fashion Show will get first priority. Previous participants are randomly selected from completed applications.

Application and AV Release Agreement must be received by Friday, February 12, 2016:
Send to: Rachel Weingarten, Community Training & Consultation, 122 E. Olin Ave., Ste. 100, Madison WI 53713
FAX: (608) 263-4681 | Email: | Phone: (608) 890-0777

AUDIOVISUAL RELEASE AGREEMENT

I hereby authorize and give full consent to the Waisman Center, University of Wisconsin-Madison, to publish or otherwise use photographs, videotapes, and/or audiotapes in which I, ______appear.

Print your full name or name of person you are guardian for

It is further agreed that the Waisman Center, University of Wisconsin-Madison, may use or cause to be used these materials for any and all educational publications and promotional purposes without limitation, reservation, or any compensation. This authorization extends to printed newsletters, brochures, posters, video, and material posted on the Waisman Center website, partner website/newsletter, or a University of Wisconsin-Madison media website used to hold Waisman Center audiovisual or streaming media.

___ Check here if you agree to identification of person in audiovisual material by name

___ Check here if you DO NOT want person in audiovisual material identified by name

Date______

Print Name ______

Signature ______

Street Address ______

City/State ______Zip______

• Witness (if present) ______

2016 Fashion Show for All Abilities