Name *

First Name

Last Name

Phone *

(###)

###

####

Session Date *

MM

DD

YYYY

Time Slot *

Hour

Minute

Second

AM PM

Secondary Time Slot *

Hour

Minute

Second

AM PM

A la carte services *

No

Additional Editing

Enlarged Script Printout

Extra Rehearsal Time

Headshots

Personal Slate

Delivery Deadline *

MM

DD

YYYY

Delivery Deadline Time *

Hour

Minute

Second

AM PM

*

I release my rights for Chicago Demo Reel Productions to take my photograph, video of my image or voice recording and use my image to promote the CDR and their program in any way they see fit without limitation.