| *Your
FULL Name: |
|
| Male
or Female: |
Male
Female |
| *Mailing
Address Including
Street, Apt, Unit #: |
|
| *City: |
|
| *State: |
|
| *Zip
Code: |
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| If
Above Address is not permanent, include Permanent Address
and Dates You Will Reside: |
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| *Telephone: |
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| Cell
Phone: |
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| Other
Phone Contact: |
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| *Email
Address: |
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| *Date
of Birth: |
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| *Current
Age: |
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*What Contest are You Interested in? |
National
Pageants: |
National Competitions (Open to anyone)
America's National Miss (ages 18 and over)
National 2006 Teen (ages 14-19)
America's National Mrs. (ages 21 and over)
What city/state you want to represent:
|
| Kentuckiana Pageants (residents of Kentucky and Indiana): |
Mrs. Kentuckiana (ages 21 & over)
Miss Kentuckiana (ages 18 – 25)
Kentuckiana Teen (ages 14 – 19)
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| Open to Anyone (no resident requirement): |
PageantCrown's Little Miss (ages 2 – 13)
Teen Princess (ages 14 – 17)
Ms. Kentuckiana (20 and over, not married)
|
| Interested in Representing the USA at the Following International Contest: |
|
| List
Hobbies, Interests & Activities: |
|
| How
Did You Hear About Us? Please
list name of: Friend, Pageant, Program Book, Ad, Website,
Link, Radio, TV, Magazine, School, Press Release, Reigning
Queen, Social Event or Other: |
|
| Please
list any previous or current pageant or modeling titles
won/held: |
|
| Please
list any previous pageant or modeling experience: |
|
| By
entering as an official contestant, you agree to participae
and pay the required entry fees. |
Yes, I am
entering as an official contestant
I am requesting official
information |
| Please add me to the e-mail Newz List |
Pageant Crown E-Newz Letter |
If you are entering as an official contestant (you plan to pay the entry fee and compete in our next contest) then complete the items below. If you are just requesting information, the following items are optional. |
| Please list awards, honors, achievements: |
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| Please List Education Experience, past, current and future: |
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| Please list community, school, work involvement, any leadership postions |
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| Tell Us About Your Family: |
|
| List Three of your favorite things: |
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| Why are you entering the competition? |
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| Words to describe your personality and character : |
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