Roker Media LIVE STREAMING NETWORK Questionnaire

Please fill out the following below because the more we know about you, the faster we can sign you up!

Your name
Your email
Confirm your email
Your birthdate
If under the age of 18, please include contact information for a parent or legal guardian
Parent/guardian name
Parent/guardian email
Describe your talent (300 characters max):
Describe your goals (500 characters max):
Are you currently signed by a manager or agent?  Yes No
If yes, who?
Who is the celebrity or personality that you could be compared to? (200 characters max)
Is there anything else that you'd like to tell us? (500 characters max)