2004 National Online Entry Form

Please complete the entry form and Emcee sheet below and submit it along with your paypal.com entry fee or deposit to the address below. Entry must be submitted with at least a $125.00 deposit by April 17th 2004.  To obtain a printable Entry fee you may either print this form from this page and mail your check or money order to the address below. Thank you.

[FrontPage Save Results Component]
Contestants Name
Age Group
Birthdate
Address
City
State Zip Code
Email
Phone

Emcee Sheet

Name
Age
Birthdate
Parents
Address
City
State Zip
Hair
Eyes
Pets
Favorite Food
Favorite Person
Referred by:

Check the applicable boxes beside your choice with a X

Beauty Only: (no discounts apply) $200.00
Supreme Package (includes Beauty Divisional, Swimwear, 1 Photogenic picture, Ultimate & Total Supreme) $395.00
Beauty Supreme (beauty scores plus any points gained)
the title and cash award.		 $75.00
Swimwear Supreme (judged during swimwear competition)
Free Sweetheart Supreme (for contestants not winning over $600.00 cash only/free with all events)		 $50.00
Optional Events      
Sportswear (required for Supreme Titles) $75.00
Outfit of Choice (replacement score) $75.00
Most Beautiful Face (1 bonus point)  $50.00
Beauty Optionals (eyes, hair, smile, personality, fashion, .5 each) $50.00  
Overall Awards - Sportswear, Photogenic, Most Beautiful Face $50.00 
Additional Pictures - May be Black &White or Color (no limit) $20.00 each 
     
Admission: Adult (this covers all events & crowning)  $20.00
Admission: Children 4-12 (under 3 free) $10.00

Totals

Total Package
Subtotal for All Events
Less Deposit $ Due by April 17th 2004 - 125.00
Special $200.00 Discount  (must be received or postmarked by April 17th) (must enter all categories)
Balance due
I verify that my child has never won over $1,200.00 cash. If found giving false information all awards will be revoked. yes/ no)
RELEASE: I understand and agree that the Directors, nor the staff, shall be held liable for property damage, loss of property, or personal injury anytime during or subsequent to the pageant. I understand that the judges decisions are final and that bad sportsmanship can result in disqualification without refund. I also agree that any videos or photos taken during or after the pageant may be used for advertising purposes. I fully understand all rules and regulations of this pageant. If we are entered in Novice Supreme 

Signature:   

Date:

Please complete the entry form and return it along with your fees or deposits to: 

America’s Model Miss
51402 Wolfe Road
Caledonia, Mississippi 39740 
with a $125.00 deposit by April 17th, 2004. 


Please Note: Make checks payable to America’s Model Miss. Any Fees paid after April 30th must be paid by cash or certified funds only. No checks will be accepted at the door. We will accept pay pal, please add a 4% service charge. Paypal address is modelmiss@bellsouth.net


Remember, get your Entry Form and Deposit postmarked by April 17, 2004! Only entries with a deposit will be assigned a number! Don’t delay! Get your entry in EARLY!!.....

  Hit the submit button only once, PLEASE!  

Vickie Flynn
662-256-5522

Send all Entries to:
America's Model Miss
51042 Wolfe Road
Caledonia, MS 39740


Accepted

 

This site last updated on: Thursday, July 28, 2005 02:01:46 PM

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