2008 Miss Florida Palm Teen - Miss

2009 Miss Florida Palm State Pageant tm

APPLICATION FOR JUNIOR AGES 10-12, TEEN AGES 13 TO 16, MISS AGES 17 TO 23, Mrs 21-up and/or Married

(MUST SUBMIT ORIGINAL APPLICATION PLUS 4 COPIES FOR THE JUDGES)

FULL NAME ___________________________________________BIRTHDAY ____________________ AGE ______

SPONSORED BY _________________________________ PARENTS NAMES ______________________________

REPRESENTING (Pageant, City, County, etc.) ______________________________________________________

ADDRESS ________________________________________CITY _________________ STATE _____ZIP ________

E-MAIL _______________________________________________________PHONE # (______) ________________

SCHOOL _______________________________CITY ____________________ GRADE __________ GPA ________

COLLEGE _____________________________ MAJOR ___________________GRADE __________ GPA _______

PLATFORM SPEECH SUBJECT __________________________________________________________________

ORGANIZATIONS ______________________________________________________________________________

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HONORS _____________________________________________________________________________________

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SPECIAL TRAINING ___________________________________________________________________________

CURRENT OCCUPATION _______________________________________________________________________

FAVORITE HOBBY ____________________________________________________________________________

PREVIOUS TITLES ____________________________________________________________________________

CURRENT TITLES _____________________________________________________________________________

FAVORITE CHARITY ____________________________________________________________________________

COMMUNITY SERVICE __________________________________________________________________________

MOST VALUABLE LESSON LEARNED IN LIFE ______________________________________________________

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HOW DO YOU INTEND TO PROMOTE THE MISS FLORIDA PALM PAGEANT IN FLORIDA: _________________

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WHY YOU ENTERED THIS PAGEANT: ______________________________________________________________

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WHERE DO YOU SEE YOURSELF IN 10 YEARS _____________________________________________________

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ADDITIONAL INFORMATION _____________________________________________________________________

Receive $25.00 off for Early registration if postmarked by 01 June 2010.

Entry fee is $150.00 for at Large Contestants & must be postmarked on or before 01 July 2010 & include all money, ads & photos.

Entry Fee is only $100.00 for Reigning Local Palm Queens, $75.00 for Prelim to Palm Queens & $125.00 for Queens of any other

Pageant within Florida. Add $25.00 for late entries.

MY ENTRY FEE IS: $ _____________

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

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

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

ONE $25.00 GOOD LUCK AD (MANDATORY/MINIMUM) $ _______ .

IF COMPETING FOR MISS FLORIDA TROPICAL PALM STATE QUEEN TITLE $50.00 $ ___________ OPTIONAL

IF COMPETING FOR MISS FLORIDA TROPICAL PALM STATE QUEEN MODEL OF THE YEAR TITLE $50.00 $ ________ OPTIONAL

SUPER SAVINGS DISCOUNT ON ENTRY! ENTER EVERYTHING ABOVE FOR $250.00 _________

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 ADMISSION TICKETS $8.00ea. # Tickets_______ Total $ ______________

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

QUEENS SOCIAL & BALL. Tickets $10.00 ea. # of Tickets _____ Total $ ___________

Tickets will be given out at rehearsal. Must be prepurchased.

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.

__________________ ____________________________________ ___________________________________

DATE PARENT OR LEGAL GUARDIAN CONTESTANT

Return Application & Signed Rules to: Todd Prowant, Director

Make Checks payable to: Miss Florida Palm

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