Universal Studios Japan® Performer Registration

Performer Registration Form
* Asterisk indicate all required fields
Title: *	Mr	Miss	Mrs	Ms

First Name: *

Middle Name:

Last Name: *

Gender: *	Male	Female

Date of Birth: *

Please Note: You must be 18 or over on the day of your audition.
Postal Address: * (No PO boxes please)

Suburb and/or City: *		Postcode: *


State or Shire: *

Country: *


Mobile/Cell Number: * (Numbers only! No spaces or punctuation.)

Phone Number:
(Numbers only! No spaces or punctuation.)	Area Code Phone Number

Email Address: *

Website Address:
youtube / blog / facebook / myspace Web Address:
Do you have an Agent? *	Yes No

If Yes Please Add Required Agent Details (Click to Open / Close tab)

Agent Company Name: *

Contact Person at Agency: *

Agent's Address:
Agent's Suburb and/or City:		Postcode:
Agent's State or Shire:
Agent's Country:
Agent's Mobile/Cell Number: (Numbers only! No spaces or punctuation.)


Agent's Phone Number: *
(Numbers only! No spaces or punctuation.)	Area Code Phone Number

Agent's Email Address: *

Height: *

Weight: *

Audition City: *

Which Describes You Best?: *

Further Details: If you need to audition for more than one category please comment in the space provided	Characters Remaining

What lead you to this web site?: *

Comments: You can use this area to let us know where you heard about this year's auditions.