Apply as a Companion Form

Apply as a Companion Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Pronouns
Height
Weight
Optional Image Upload
Availability*
(weekdays, weekends, evenings, etc)
Do you have experience as a professional companion, model, or entertainer*

YesNo
Why do you want to become a UEX Companion?*
Please Explain
What type of experiences are you most comfortable providing?*

DinnersTravelEventsAnyNot Sure
Additional skills or languages*
Upload a valid Driver's License or ID (for verification)*
Upload a Headshot (professional or clear image)
Acknowledgement: I understand that (UEX) Upper Echelon Experiences provides non-sexual companionship and social engagement services only.
Signature*

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