Featured Urban Injun
(Must be 18 years of age or older)

First Name: *
Last Name: *
Gender: *
Residing City: *
State: *
Phone #: *
Email Addr: *
Date of Birth: *
Age: *
Measurements (female applicants):
Nationality: *
Myspace url:
Describe why you (or your nominee) should be selected as the next Featured Urban Injun:
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If outside of the Phoenix area, do you have access to a professional photographer?
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How did you hear about us?
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RESTRICTIONS ON USE OF MATERIALS
If selected you grant permission to UrbanInjun.com to reproduce any photographs taken for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium.

ACCURACY OF INFORMATION SUBMITTED
By hitting the submit button you acknowledge that all of the information submitted above is accurate and true to the best of your knowledge. You also represent you are 18 years or older.
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