Mirror Images Photography
 208 W. Railroad St.
Centralia, MO 65240
 Local Phone: (573) 682-3827 Toll Free: (866) 593-3827

BE A PART OF THE DREAM TEAM
2010 Senior Model Agent Application

We accept a limited number of Studio Senior Model Agents each year to be Dream Team Members.
If you wish to be considered, fill out this form as completely as possible.


ATTENTION APPLICANTS: CLASS OF 2010
Being a Dream Team member and Model Agent is a Fantastic opportunity to receive a fun and exciting session at this area's most inspiring, innovative and fashionable senior portrait studio.

In our Model Agents we are seeking terrific, responsible, sociable, outgoing and fun high school juniors from the Class of 2010 to be Dream Team members and Model Agents for our studio to help us spread the word about our new and exciting concepts for Senior Portraits.

Referrals are the best promotional tools available. Your classmates want to know about our services and that is exactly what being a Model Agent is all about. As compensation for their efforts Model Agents enjoy complimentary benefits as well as have the opportunity to earn additional portraits. All Model Agents selected will receive at least the following:

Here's how the program works...

 OK! To get started, just complete the application below and submit it. We'll contact you shortly to let you know if you've been approved. Remember, we are only able to select a limited number of juniors from each school, so the sooner you apply, and the more information that you provide, the better your chances of being approved.



This form will help our studio get to know you better and be able to provide you with a more personal Senior Portrait Experience. We want you to have Senior Portraits that you are excited about and will cherish forever.       Randy and Sheila Pauley

Important note: We will not schedule your photography session without listing parent contact information. DO NOT SURPRISE YOUR PARENTS, DISCUSS THIS WITH THEM FIRST BECAUSE WE WILL CONTACT THEM! If your parents have email and work/cell phones it is important that it is listed for us to contact. Anyone not listing that information will not be considered.

* = Required Fields

Students Full Name:*  

Mother's First and Last Name:*  

Father's First and Last Name:*  

Street Address:*  

City:*  

State:*  

Zip Code:*  

Home Phone Number plus Area Code:*  

Mother's Work/Cell Number plus Area Code:*  

Father's Work/Cell Number plus Area Code:*  

Your Email Address:*  

Parents Email Address:*  

Your High School:*  

This next Section is to help me know you and your personality

If you have a MySpace account, what is your MySpace URL?
(Shown on your MySpace home page) 

If you have a Facebook account, what name are you listed as? 

Your Gender: 

What are your average grades: 

Do you play a sport: 

 YES NO

What sports do you play, check all that apply: 

 Football Basketball Baseball
Track or Cross country Softball
Golf Tennis Wrestling
Swimming Hockey: Field/Ice/Roller
Volleyball Martial Arts
Gymnastics Cheerleader
Soccer
Other:

Are you involved in the Arts, check all that apply: 

 YES NO

What Arts are you involved in, check all that apply: 

 Painting Writing Dance
Choir Musician
Drama Band
Other:

Other School Activities: 

 Student Officer FFA
Debate Team Language Club
Military Yearbook/Newspaper
Art Club FBLA FCCLA
FTA Interact Key Club
NHS Quiz Bowl Status
Other:

Other Non-School Activities: 

 4H Work Volunteer
List other non-school activity: 

What is your favorite music: 

What is your favorite radio station,
your favorite music groups.

Describe your personality?: 

Do you want to include a pet?: 

 YES NO
  What Kind?

Do you want to include a friend, boy/girl friend?: 

 YES NO    Who?

Are you excited about having your Senior Portraits Done: 

 YES NO

Tell us why you would like to be a 
Mirror Images Model Agent for your school:* 

What will you do that will make you a superior 
Model Agent for Mirror Images over others?:* 

What do you think of when you have seen 
portraits from Mirror Images Photography?:* 

Tell us anything else you feel 
may help your application: 

Thanks for taking the time to fill out this application.  None of the information we receive from you is ever shared with any other web site or advertisers.  This information is for our use only.

Please get your applications in early!! Applications will be taken until positions are filled or until March 30, 2009, whichever comes first.

Who is submitting this form?* 

Choose One: 
I am under 18 and have my parents consent
I am 18 or Older

Persons name submitting this form?* 
Please provide your Email Address:* 

Please Click Submit form when finished.

 

Call or E-mail your request for more information.
All photos © Copyright 2008 Mirror Images Photography
Web site © Copyright 2008 Mirror Images Photography
Revised: May 5, 2008
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