PERFORMER RECORD as requested by 18 USC 2257
Performer's present
and correct name: (lastname, firstname middlename): |
Performer's professional name (alias) for use with this company's productions: |
Any other names ever used by the performer including maiden name, aliases, nicknames, stage names, DBAs, or professional names: |
Attached to this record, or stored with this record, is a copy of a passport issued by the United States or a foreign country, a green card issued by the U.S., or driver’s license or identification card issued by a State, which bears the photograph and the name of the individual. Complete 1 of these 3: -Passport -Driver's License -State Photo I.D. -U.S. Green Card |
Performer's Present Age: |
Performer's Date of Birth: |
Date Performer's I.D. was examined: |
Performer's I.D. was examined by (name): |
Depictions of this performer are published in/on the following Works:
WEBSITE URLS: |
VIDEO TITLES OR VIDEO IDENTIFYING NUMBERS: |