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Entertainer Sign Up

Are you an Entertainer or do you provide a Service for Seniors?

Please fill in the following form to sign up for your Profile page:
*required fields

Contact Information:

*First Name
*Last Name
*Address
*City
*Province
*Postal Code
*Phone
Cellular
Fax
*E-mail
*Confirm E-mail

Note: Of your contact information only your e-mail address and phone
number will be displayed on your Entertainer Profile page.
Contact information collected will not be given to any third party and is only used
by WeEntertainSeniors.com when necessary for following up with your account.

Profile Information:

*Performer/Company Name
*Select Hourly Rate
*Detailed description

*Category

Note: Your registration fee allows you one Entertainer Profile page in a single category. You may add a second profile at a reduced price as a one time offer during your initial registration should you want to add a listing to a second category.


Website URL http://
YouTube URL

*How far are you willing to travel to work?

**Password
**Confirm Password
**required, max. 10 characters
Your password will allow you to login to edit your Profile page

How did you hear about us?
I would like newsletters by email from WeEntertainSeniors.com
*I agree to the terms of the WeEntertainSeniors.com User Agreement