South Central Contestant Registration 2017
1. Complete the Contestant Registration in its entirety online.
2. Attach an electronic copy of the front page of your passport our driver's license with the numbers blacked out, clearly showing proof of your age.
4. Your bio should be input in this form. (max. 750 characters; spaces included) - after 750 characters (spaces included) your bio will be cut off.
5. Attach an electronic copy of your head-shot photo (max. 3" x 3", 300dpi, 800 x 600 pixels or greater- JPG or PNG).
6. Contestant registration fee is due at the time of submitting this form and is non-refundable.
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Contact Phone Number:
Pronoun Preference: (BoothBlack only) (He or She)
Specific Medical or Other Needs:
Body Modifications: (tattoos, piercings, etc.)
Cock Size: (if applicable)
Cut? Uncut? NA?
Have you ever been arrested, indicted or covicted of a felony?
Have you ever appeared in any pornographic photos, films or videos?
Hankie Colors; Left
Must be at least
Hankie Colors; Right
Must be at least
Must be at least
Length of time in the community:
Do you have a current passport:
Family Structure (single, partnered, triad, etc.)
Briefly, what do you hope to accomplish during your title year:
Must be between
I, the undersigned, agree to comply with all the rules and regulations set by South Central Leather Contest, Inc., my regional producer and the management of the facilities where the events are held.
I certify that all information I have provided on this form is accurate.
I certify that I am 21 years of age or older and meet all of the qualifications specified in the CONTESTANT REQUIREMENTS portions of this application and agreement. I further agree to comply with all of the requirements described within this attached application and agreement contract and with the statements of expectations and responsibilities of the winners.
I certify that I have read and fully understand the Contestant Requirements located at www.SouthCentralLeather.com
I understand that registration is not considered final until payment is received.
DISCLAIMER AND RELEASE OF LIABILITY:
I, the undersigned, in consideration of the acceptance of my entry herewith by the owners the contest, South Central Leather, Inc., hereby waive, release and forever discharge its owners, producers, members, agents, operators, employees, lessors, lessees, parent companies or entities, affiliated companies or entities, representatives or subsidiaries from any and all demands, actions, causes of actions, claims of injury or damage to my person, property or reputation, costs, damages expenses, attorney’s fees or penalties of any kind or nature, whether asserted or unasserted, known or unknown, that may arise now or in the future from any cause whatsoever in connection with my participation in and with the South Central Leather.
I, the undersigned, also hereby grant to the South Central Leather, Inc. and its licensees, agents, successors and assigns, the exclusive right and permission to own, print, reprint, broadcast, reproduce, and publish any and all photographs, negatives, video and audio recordings, and other electronic media and mechanical images of me, which are taken during any local, regional or international competitions, rehearsals, photographic modeling sessions, receptions or other related events. All photographs and images of me shall be the property of the South Central Leather, Inc., who shall have the exclusive right to use the photographs and images for any purpose whatsoever in any media or context.
I agree to participate, if asked to do so, in a photographic modeling sessions arranged by the South Central Leather Board of Directors during the South Central Leather Weekend Weekend Contest at a location within the United States. I understand that the photographs may be used exclusively by South Central Leather in its advertisements, website and promotional activities, and for no other purpose unless I grant written permission. I understand that nudity is not required but is optional. I shall receive no compensation for modeling other than the prizes that are awarded to me, if any, as a contest winner.
I hereby release, discharge and agree to hold harmless the South Central Leather, Inc., its officers, Board of Directors, board, and agents, photographers, licensees, agents, successors and assigns, including all publishers, distributors and web masters who may publish, distribute, broadcast, or otherwise use photographs and images of me, from any liability or claim arising from the publication, distribution, broadcast, or other use of any photographs and images of me, including any distortion, blurring, alteration, optical illusion, or use in composite form, either intentionally or otherwise, that may occur or be produced in the taking, processing, or reproduction of the photographs and images of me, their publication, distribution or broadcast.
I certify that I am (21) twenty-one years of age or older, and have read these releases before signing them. I have attached a photocopy of the front page of my passport and driver’s license (with the numbers blacked out) which shall be used for identification purposes only and shall not be published
Signature (By typing your name below, you affirm that all information you have entered is actuate)
Head Shot: (This will also be used in the 2017 South Central Yearbook)
Please check the box below.
Do Not Fill This Out