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Application Form

Please fill in the following application. Fields marked with a '*' are required. (All your information will be kept confidential, we promise. Cross our heart.)

First name *
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Birthdate * Date Month Year

With which Company or School are you affiliated? *
     Name
     City
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How did you find out about Yumiko?
     

Do you own any Yumiko pieces? *   0-5   5-10   full closet

What is it about Yumiko you like?
     

Do you know about Yumiko Takeshima the dancer/designer?
   No   Yes     

How did you find out about becoming a YumiGirl or YumiGuy?
     

Do you have regular access to a computer? *   No   Yes

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