| Type or print neatly CONTESTANT APPLICATION
_____________________ Division _____________________________________________________________ ________ ________________ ______________________________ NAME AGE BIRTH DATE TELEPHONE ____________________________________________________________ _______________________________________ _________________ ADDRESS CITY ZIP Hair Color _______________________________________________Eye Color ________________________________Height ________________________ � Mothers Name _____________________________________________________ Fathers Name ________________________________________________ School ______________________________________________________ Grade ___________ Favorite/Major Subject ____________________________ � Employer _________________________________________________________________________________________________________________________ Which Major State pageant would you like to compete in?_________________________________________________________________________________ � Do you currently hold a title? _______________ If so, what? _______________________________________________________________________ � Hobbies/Interests/ Talents__________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ � _________________________________________________________________________________________________________________________ ______ � _________________________________________________________________________________________________________________________ ______ � Dream Vacation Location __________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ ______ Most Memorable Experience ________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ ______ � _________________________________________________________________________________________________________________________ ______ � Who inspires you & why? _________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ ______ � _________________________________________________________________________________________________________________________ ______ � Best Asset ______________________________________________ One word that best describes you __________________________________________ � Life Ambition ___________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ ______ Favorite Midnight Snack__________________________________________________________________________________________________________ School/Community Involvement_____________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ � _________________________________________________________________________________________________________________________ ______ � _________________________________________________________________________________________________________________________ ______ Daily Philosophy_________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ ______ � _________________________________________________________________________________________________________________________ ______ � Platform ________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ � Sponsor(s) ______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________ E-MAIL: _____________________________________________________________________________ |
| Please include snapshot or
Wallet size photo for program This will be returned to you |
| MAKE CHECKS PAYABLE TO: IMPERIAL IMAGE WEBSITE: www.CitrusValleyPageant.com |
| MAIL TO: IMPERIAL IMAGE P.O. Box 345 Newberry Springs, Ca. 92365 |
| AGREEMENT: I herby certify that I have read and understand the rules and requirements and agree to abide by and be bound to the same throughout the competition and thereafter should I achieve the title for which I am competing. In the event of any injuries or damages suffered as a result of my competing in this pageant or associated activities, I hereby release from liability any and all persons or premises associated with the production of the Miss Citrus Valley Pageant. I further agree to the use of any photographs or videos/DVDs containing my likeness to be used for publicity and promotional purposes. My signature below and that of my parent or guardian if I am under 18 years of age shall constitute this form to be a binding agreement and contract. _______________________________________________________ Contestants Name (Printed) _______________________________________________________ _______________________ Contestants Signature Date _______________________________________________________ Parent or Guardian Name (Printed) ________________________________________________________ _________________________ Parent or Guardian Signature Date |