Riley Smith MasterClass Registration Form

Riley Smith Acting MasterClass Registration Form

Please fill in the form below. One person per form.
Full Name

First NameLast Name
Age:
Sex:
Parent (If Minor)
Parents Name
Phone Number

Area CodePhone Number
E-mail
Height (If Model):
Emergency Contact

First NameLast Name
Emergency Contact Phone

Area CodePhone Number
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Referred By:

Other
If referred by a friend or Ambiance Staff please list name:
Riley Smith Acting MasterClass

Workshop Date: Saturday, October 17th
Meet & Greet - 9:30am-10:00am

MasterClass - 10:00am - 4:00 PM

Riley Smith MasterClass Deposit$100.00

Non - Refundable Registration Deposit

Remainder due no later than the start of the workshop$299.00

Remainder of Workshop Cost

Total $0.00

Signature
Release Agreement: As participant or parent / guardian of the above participant, I give my permission for myself or my child (if under 18) to participate in the acting and/or modeling workshop. I agree to indemnify and hold harmless Ambiance Models & Talent, Inc., Riley Smith, and its sponsors, instructors and employees against any loss, damage, injury or other conditions arising out of myself or my child’s participation. I understand that all registration fees are non-refundable. Also, in consideration of the potential for additional publicity, I hereby authorize use of my photos, video or television for future use and advertising.
By clicking on "yes" and submitting my registration I am agreeing to the following: I have read and understand the form in its entirety. I am signing this form electronically. Also by clicking "yes" I am stating that I am the person registering, and I give permission for my credit card entered on this form to be charged.
Should be Empty:

Riley Smith Acting MasterClass Registration Form