2011 Miss Florida Palm Junior - Miss

2011 Miss Florida Palm State Scholarship 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 _____________________________________________________________________________

ADDRESS _______________________________________CITY _________________ STATE _____ZIP ________

E-MAIL ______________________________________________________PHONE # (______) ________________

SCHOOL _______________________________CITY ____________________ GRADE _________ GPA _______

COLLEGE _____________________________ MAJOR ___________________GRADE _________ GPA _______

PLATFORM SUBJECT _________________________________________________________________________

ORGANIZATIONS _____________________________________________________________________________

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HONORS ____________________________________________________________________________________

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SPECIAL TRAINING __________________________________________________________________________

CURRENT OCCUPATION ______________________________________________________________________

FAVORITE HOBBY ___________________________________________________________________________

PREVIOUS or 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 ____________________________________________________________________

Entry fee is $150.00 for at Large Contestants & must be postmarked on or before 1 July 2011.

Entry is $125.00 for Queens of any other Pageant within Florida

Entry fee for Prelim Pageant Queens is $75.00.

All Entries must include Application, all money, ads (Ready to be copied), music CD's & photos. Add $25.00 for late entries.

MY ENTRY FEE IS: _______________

I AM ENTERING THE FOLLOWING OPTIONALS AT $15.00 EACH!

_______ BEST ATTIRE _______ 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

PROGRAM BOOK $15.00 $ __________ OPTIONAL

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.

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DATE PARENT OR LEGAL GUARDIAN CONTESTANT

Return Signed Application to: Tonya Rowe, Director

Make Checks payable to: Miss Florida Palm

Send Application to: 14701 NW County Rd. 274, Altha, Fl 32421

Application Refered By: ________________________________________