_____ Contestant #'s
Name:_____________________ Age:____________________________
Date of Birth_________________Age Division:____________________
Address:___________________________________________________
E-Mail:_____________________________________________________
Hair Color: ____________ Eyes: _____ Best friend:________________
Parents:___________________________________________________
Sisters:______________________ Brothers_______________________
Favorite Food:_______________Favorite Person:_________________
School Attending:___________________________________________
Ambitions:__________________________________________________
___________________________________________________________
Hobbies:____________________________________________________
___________________________________________________________
Sponsored By:_______________________________________________
Door Admissions; General admission $7 each under 3 free
I understand and agree that the Directors nor the place of staging, will be held rresponsible for
any accident, injury, theft or personal loss incurred at the pageant or in transit to and from the pageant. I also agree
and understand that the Judge's decisions are final and poor sportsmanship will NOT be tolerated.
__________________________
Parenmts/Guardin Signature
Entry Fee $50________
Earlybird first 30 only $35 if paid in full by January 15, 2010_______
If you pay day of pageant you are subject to a $10 late fee
Must add 4% to cover fee's from Paypal:
example: If paying $35 you must send in $36.40
If paying $50 through paypal you must send in $52.00
Mail entries to: Vickey DiMattia P.O. Box 1241 Independence La 70443
