Application

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Race:

   

Sexual Preference:

  

Date of Birth:

   

Age:

  

Release Date:

   

Marital Status:

  

Height:

   

Weight:

  

Measurements:

   

Eye Color:

  

Hair Color

   

How Many Children

  

Religion:

   

Racial Preference:

  

Education:

   

Do You Smoke:

  

Occupation/Career:

   

Home Town:

  

Willing to relocate?

   

Nationality:

  
Name:                            Title or Heading:

Write to me at:

 
 
 

Please tell us with about 150 words or less, about your interest, any hobbies, enjoyable activities, plans for the future, or the type of things you would find interesting in other people. Write on other side if more room is needed.________________________________________________________________________

 

 

 

 

________________________________________________________________________

Todays Date:   

Mail Application To:

PBI

c/o McLloyd

P. O. Box 3621

Wichita, Ks.  67201