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|TAKE ME OUT |
|GIRLS |
|APPLICATION FORM |
|FULL NAME: (as on passport) |DATE OF BIRTH: |
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|FIRST NAME THAT YOU PREFER TO BE CALLED ON THE SHOW: |AGE: |
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|HOME ADDRESS: |
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|YOUR CONTACT NUMBERS |
|OFFICE: |
|HOME: |
|MOBILE: |
|YOUR EMAIL ADDRESS: |
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|CITY OR TOWN ORIGINALLY FROM: |
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|ARE YOU: SINGLE / MARRIED / SEPARATED / DIVORCED |
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|HAVE YOU EVER BEEN MARRIED OR ENGAGED? IF YES – HOW MANY TIMES? |
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|WHO DO YOU LIVE WITH? |
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|HOW TALL ARE YOU? (in Feet and Inches) |
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