BAZAAR Backstage Application

* required

PERSONAL INFORMATION

* First Name
* Last Name

* Address

* City
* State
* Zip Code

* Email Address
* Birthdate (MM/DD/YYYY)

* Gender

* Marital Status

* Household Income

Male Female

Single Married/Partner

* Ethnicity

EMPLOYMENT

* Employer & Job Title
What are your job responsibilities?

EDUCATION

School Name
Degrees Earned

PERSONAL INTERESTS

Please list any hobbies/interests.
Are you involved in any clubs or charities? If so, please list.
How would you spend your ideal weekend?

SOCIAL NETWORKING

* Are you a member of Facebook? Yes No
If you answered yes, what is your Facebook address?
Approximately how many
Facebook friends do you have?

* Do you have a Twitter account? Yes No
If you answered yes, what is your Twitter name?
Approximately how many
Twitter followers do you have?

* Do you have a blog? Yes No
If you answered yes, what is the name of your blog?
Approximately how many
blog followers do you have?

Approximately how many people are in your "clique" of friends?

HARPER'S BAZAAR

Why do you read Harper's Bazaar?

Which other magazines do you read?

* Why should we choose you to become a Leaders member?

* How did you come to find out about The Leaders

PHOTOS/VIDEO

* Upload a photo or video:

Video or Image file: [Max size:20MB]

Additional Photos (optional):

Photo 1: [Max size:5MB]

Photo 2: [Max size:5MB]

Photo 3: [Max size:5MB]