2011 Miss Florida Palm Baby Miss - Little Miss Application

2011 Miss Florida Palm State Scholarship Pageant tm

APPLICATION FOR: BABY 0-23 Months, TEENY AGES 2 TO 3, TINY AGES 4 TO 6 & LITTLE AGES 7 TO 9

(MUST SUBMIT ORIGINAL APPLICATION PLUS 1 COPY FOR THE EMCEE)

FULL NAME ________________________________________________________________________________

PREFERED NAME _____________________________________ BIRTHDAY _________________ AGE ______

SPONSORED BY ____________________________________________________________________________

PAGEANT REPRESENTING ___________________________________________________________________

PARENTS __________________________________________________________________________________

MAILING ADDRESS_______________________________________________ CITY ______________________

STATE ________ ZIP ____________ E-MAIL ______________________________________________________

TELEPHONE _(______)_____________________ SCHOOL _____________________________GRADE ______

HOBBIES ___________________________________________________________________________________

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HONORS ___________________________________________________________________________________

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FAVORITE HOBBY ____________________________________________________________________________

FAVORITE CHARITY ___________________________________________________________________________

WOULD MOST LIKE TO MEET __________________________________________________________________

WOULD MOST LIKE TO VISIT __________________________________________________________________

FAVORITE TV SHOW ______________________________ FAVORITE MOVIE STAR ______________________

FAVORITE FOOD _________________________________ FAVORITE COLOR ___________________________

SOMETHING SPECIAL OR UNIQUE ABOUT YOU ___________________________________________________

_____________________________________________________________________________________________

PREVIOUS or CURRENT TITLES ________________________________________________________________

ADDITIONAL INFORMATION ____________________________________________________________________

Entry fee is $150.00 for at Large Contestants & must be postmarked on or before 01 July 2011.

Entry Fee is $150.00 for Local & Regional Palm Queens ($75.00 paid by Contestant & $75.00 Paid by Director).

Entry fee for Prelim Pageant Queens is $100.00. (Paid by Contestant). ie Firecracker, Pumkin Princess, Sunshine,

Relay for Life, Emerald Coast Our Little Miss, Etc.

Entry is $125.00 for Queens of any other Pageant within Florida. Add $25.00 for late entries until 15 July 2011.

All Entries must include Application, all money, ads (Ready to be copied), music CD's & photos.

MY ENTRY FEE IS: _______________

I AM ENTERING THE FOLLOWING OPTIONALS AT $15.00 EACH! OR ALL 7 FOR $75.00.

_______ PRETIEST SMILE _______ PRETTIEST EYES _______ BEST ATTIRE _______ PRETTIEST HAIR

_______PRETTIEST FACE _______ BEST PERSONALITY _______ PHOTOGENIC - AT $10.00 EXTRA FOR EACH. UP TO 4.

(OPTIONALS) = $ _______

ONE $25.00 GOOD LUCK AD (MANDATORY) $ _______ . Include you 15 words of Good Luck written below photo from Family, Friends or Business.

IF COMPETING FOR LITTLE MISS FLORIDA TROPICAL PALM STATE QUEEN TITLE (TALENT) $50.00 $ ________ OPTIONAL

IF COMPETING FOR LITTLE MISS FLORIDA TROPICAL PALM STATE QUEEN TITLE (SWIMWEAR) $50.00 $ ________ OPTIONAL

IF COMPETING FOR LITTLE MISS FLORIDA TROPICAL PALM STATE QUEEN TITLE (MODEL) $50.00 $ ________ OPTIONAL

SUPER SAVINGS DISCOUNT ON ENTRY! ENTER EVERYTHING ABOVE FOR $300.00 _________

PROGRAM BOOK $15.00 $ __________ OPTIONAL

PHOTO CD WITH ALL PICTURES OF CONTESTANT $15.00 $ ___________ OPTIONAL

DVD OF PAGEANT $30.00 $___________ OPTIONAL (DVD & PHOTO CD) $40.00 $ __________ OPTIONAL (A $5.00 Savings)

PREPURCHASE PAGEANT ADMISSION TICKETS $8.00 ea. # of Tickets_______ Total $ __________

(Will be given out at Rehearsal) A $2.00 Savings Each.

TOTAL ENTRY FEE $ _______

I certify by my signature below, that I have read, understand and will comply with the Pageant rules and regulations

set forth below and on the pageant website at www.prowant.net rules and information page. CONTESTANTS AGREE

TO HOLD HARMLESS THE MISS FLORIDA PALM PAGEANT, THE DIRECTORS, THE VOLUNTEERS, THE LOCATION OF THE

PAGEANT AND ITS HOLDINGS FROM DAMAGES INCURRED THROUGH LOSS, THEFT, OR INJURY CAUSED BY OR DURING HER

PARTICIPATION OR TO AND FROM THE PAGEANT OR ANY RELATED EVENTS. I HEREBY ACKNOWLEDGE THAT I HAVE READ

THE OFFICIAL RULES AND REGULATIONS SET FORTH BY THE PAGEANT AND THAT I WILL COMPLY WITH THEM IN EVERY

WAY, AND THAT THE PERSONAL DATA THAT I HAVE SUBMITTED IS TRUE AND CORRECT. I GIVE PERMISSION FOR MISS

FLORIDA PALM STATE PAGEANT TO USE MY DAUGHTERS PICTURE FOR PUBLICITY.

PLEASE SIGN BELOW.

____________ ______________________________ ____________________________

DATE PARENT OR LEGAL GUARDIAN CONTESTANT

Return Signed Application to: Todd Prowant, Director

Make Checks payable to: Miss Florida Palm

Send Application to: Prowant's 10126 N.W. Prowant Ln., Clarksville, FL. 32430

Application Refered By: ________________________________________