2022 Model Consent Form

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We are excited to be back together this year on the runway at a new venue - The Masonic Temple in Downtown Detroit on Saturday, October 8th.

Please complete the model consent form below if you are interested in being a model for our 2022 event.

For more event information visit, www.brasforacausemichigan.org or contact Megan at mhengesbaugh@gildasclubdetroit.org.

First Name *

Last Name *

Address *

City, State, Zip *

Phone Number *

Email *

T-Shirt Size *

Medium

XXL

Are you currently in treatment?

Yes

Clear selection

How many years in remission/survivor? *

Have you modeled for us before? *

Yes

Including this year, how many years have you modeled? *

Please provide a short bio (diagnosis, involvement at Gilda's, hobbies, etc). Information from your bio will be used for your fundraising page as well as the stage show. *

Would you like to be added to the model Facebook group?

Yes

Already a part, thanks!

Clear selection

What is the best way to find you on Facebook? (What is your Facebook name?)

Do you currently have any ideas for sponsors and/or donations?

Bra Size (only needed if you are selecting a bra from one of our art bra artists)

We have hair and makeup artists the day of the event. Please mark below if you are interested in these services. *

Just Hair

Just Makeup

Both Hair and Makeup

Neither Hair and Makeup

Unsure at the moment

Please note that there will be photos and videos taken during the event. They may be used in the following ways: for use in and around Gilda’s Club Metro Detroit, use in Gilda’s Club Metro Detroit and/or Gilda’s Club/CSC Headquarters newsletters, outreach and fundraising publications, websites, and use in television or news publications. *

Column 1

I understand that by signing this form, I give Gilda’s Club Metro Detroit permission to use photos and videos of myself.

Anything additional you would like us to know :)

Submit

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