Miss Georgia Palm ages 0-9
2011 Miss Georgia Palm State Pageant
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 ____________________________________________________________________________
REPRESENTING (Pageant, City, County, College, etc.) ______________________________________________________
PARENTS __________________________________________________________________________________
MAILING ADDRESS_______________________________________________ CITY ______________________
STATE ________ ZIP ____________ E-MAIL ______________________________________________________
TELEPHONE _(______)_____________________ SCHOOL _____________________________GRADE ______
HOBBIES ___________________________________________________________________________________
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HONORS ___________________________________________________________________________________
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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 ___________________________________________________
_____________________________________________________________________________________________
FAVORITE HOBBY ____________________________________________________________________________
PREVIOUS TITLES ____________________________________________________________________________
CURRENT TITLES _____________________________________________________________________________
FAVORITE CHARITY ___________________________________________________________________________
ADDITIONAL INFORMATION ____________________________________________________________________
Entry fee is $125 for contestants from Georgia Southern Miss, Soldiers Sweetheart, Ft. Stewart & Altamaha Southern Miss.
Entry Fee is only $150.00 for Reigning Queens of any other Pageant within Georgia.
Entry fee is $175.00 for at Large Contestants.
Must be postmarked on or before date TBA & include application, all money, ads ready to be copied & photos.
Late entries accepted with a $25.00 late fee.
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 (write below) from Family, Friends or Business.
IF COMPETING FOR LITTLE MISS GEORGIA TROPICAL PALM STATE QUEEN TITLE (SWIMWEAR) $50.00 $ ________ OPTIONAL
IF COMPETING FOR LITTLE MISS GEORGIA TROPICAL PALM STATE QUEEN TITLE (MODEL) $50.00 $ ________ OPTIONAL
IF COMPETING FOR LITTLE MISS GEORGIA TROPICAL PALM STATE QUEEN TITLE (TALENT) $50.00 $ ________ OPTIONAL
SUPER SAVINGS DISCOUNT ON ENTRY! ENTER EVERYTHING ABOVE FOR $300.00 _________
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 GEORGIA 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
GEORGIA PALM STATE PAGEANT TO USE MY DAUGHTERS PICTURE FOR PUBLICITY.
PLEASE SIGN BELOW.
____________ ______________________________ ____________________________
DATE PARENT OR LEGAL GUARDIAN CONTESTANT
Return Signed Application to: Cherie Foster, Director
Make Checks payable to: Miss Georgia Palm
Send Application to: Cherie Foster 33 Dogwood Ext., Jesup, Ga. 31545
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