SOUTHERN UNIVERSITY DEPARTMENT OF BANDS

DANCING DOLL MEMBERSHIP APPLICATION FORM

Full Name
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Date of Birth (dd/mm/yyyy)

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AddressEnter Address

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City:
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State:
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Zip code:
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Country:
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SS#
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Parent/Guardian's Name
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Are you a Transfer Student?
YesNo

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If so, what college/university are you transferring from?
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High School Attended
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Height (Without Shoes)
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Bust
Enter Years Played

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Years in Band
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Weight
Enter Secondary Instrument

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Valid Email Address
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Probable Major in College?
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On CampusOff Campus

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I Accept

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Please list Dance Experience
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You plan to live

Please enclose a full length photograph attired in one of the following: swim suit, majorette suit, or leotards.

Notes:

- Upon receipt of this application, your name will be placed on our mailing list so that you may receive additional information

regarding audition and some other matters.

Qualifications for Dancing Doll

1. Ability to perform Tap, Jazz, Modern Dance, and Ballet.

2. Minimum of 2.0 G.P.A. and twelve (12) academic hours per semester

I, the applicant for this form warrant the truthfulness of the information provided in this application.

I understand that checking this box ( I Accept) constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Additional Links

- Southern University

- Human Jukebox Alumni

Contact Information

P.O. Box 9621,

Baton Rouge, LA 70813

Ph. 225.771.3528

info@humanjukebox.com