EXA Model Submission

1
Name* This field is required.
First Name
Last Name
2
Instagram Name* This field is required.
3
Instagram Name URLie. https://instagram.com/yourIGname
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Instagram # Followers* This field is required.ie. 20525
5
TikTok Name* This field is required.
6
TikTok Name URLie. https://tiktok.com/@yourTikTok
7
TikTok # Followers* This field is required.ie. 20525
8
Snapchat
9
How many friends on Snapchat
10
Do you see yourself as a* This field is required.
Model
Creator
Influencer
Artist
Athlete
Gamer
YouTuber
Streamer
Other
11
Are you on any other social apps
Digis
Snapchat
YouTube
X (Twitter)
Twitch
Lemon8
Kick
Other
12
Do you use any of these communication apps
WhatsApp
Discord
Telegram
WeChat
Other
None
13
Date of Birth* This field is required.
Date
Year
Month
Day
14
Where are you based* This field is required.ie. Miami, FL
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
15
Height* This field is required.
Please Select
Please Select
4'10"
4'11"
5'0"
5'1"
5'2"
5'3"
5'4"
5'5"
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"
6'0"
6'1"
6'2"
6'3"
6'4"
Other
16
BustMeasurement in Inches ex. 32"
Please Select
Please Select
22
24
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62
17
WaistMeasurement in Inches ex. 25"
Please Select
Please Select
20
20.5
21
21.5
22
22.5
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23.5
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24.5
25
25.5
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26.5
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49
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58.5
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60
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61
61.5
62
62.5
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63.5
64
64.5
65
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HipsMeasurement in Inches ex. 34"
Please Select
Please Select
15
15.5
16
16.5
17
17.5
18
18.5
19
19.5
20
20.5
21
21.5
22
22.5
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25
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42
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44
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45
45.5
46
46.5
47
47.5
48
48.5
49
49.5
50
50.5
51
51.5
52
52.5
53
53.5
54
54.5
55
55.5
56
56.5
57
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63.5
64
64.5
65
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66.5
67
67.5
68
68.5
69
69.5
70
19
Dress Size
Please Select
Please Select
0
2
4
6
8
10
12
14
16
18
20
20
ShoeUS Women Shoe Size
Please Select
Please Select
3
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
10.5
11
11.5
12
12.5
13
13.5
14
14.5
15
21
Hair* This field is required.
Please Select
Please Select
Blonde
Black
Brown
Red
Shaved
22
Eye Color* This field is required.
Please Select
Please Select
Amber
Black
Blue
Blue/Green
Blue/Grey
Brown
Green
Green/Brown
Green/Grey
Grey
Hazel
23
Any tattoos? If so, where are they located?
24
Are you in College? If so, which College?Full Name ie. University of Miami
25
Do you work for a company? If so, which one:
26
Are you on any Subscription Platforms
Onlyfans
Playboy Centerfold
FanFix
WIDE
Other
None
27
Are you interested in joining a Subscription Platform? If so, which one(s)
28
If you could live in any city right now, which city?
29
How do you see EXA helping you?
Huge
Large
Normal
Small
Ok
Ok
30
Which Model or Influencer Insta do you look at the most
31
Phone #* This field is required.
Please enter a valid phone number.
32
Email* This field is required.
example@examodels.com
Should be Empty: