Model Registration 

Antoniou LTD, a manufacturer of an exclusive line of professional hair products, is getting ready to do a national product roll out with different advertisements on television and in magazines. They are testing severely damaged hair and repairing it with an amazing product, guaranteed. They need models with damaged hair to show before and after results. Members of the Antoniou Design Team with Jeannie Blankenship will be coming to examine hair and select models. If selected, you will receive a hair treatment to restore your hair to a healthy state, with strength and shine. The chosen models will also receive free hair products. Visit Jeannie's Hair Company to learn more about our credentials.  If you are interested in
becoming a model for their advertising campaign, please complete and submit the following form.  All information is held confidentially and is not shared with any other companies.

(Note: Required fields are designated with an *)

    Name:               *

    Street Address: 

    City:                  

    State:                

    Zip:                   

    Daytime Phone: 

    Evening Phone:  

    Email Address:                 *

    Confirm Email Address:   *

My hair:  (check all that apply)

    is broken off severely

    is coming out at the roots

    is damaged somewhat

    has split ends

    is frizzy

    is dull, no shine

    is baby fine

    is coarse

    is curly

    is straight

    is damaged, due to color or perm

I would like to be a model.

I would like to get my hair 100% restored to a healthy, non-damaged state.

Do you have any questions or comments?