National Southern Miss Scholarship Pageant: Teeny, Tiny, Little Application

2011 National Southern Miss Scholarship Pageant

APPLICATION FOR: Teeny Ages 0 TO 3 yrs, Tiny Ages 4 TO 6 yrs, Little Ages 7 TO 9 yrs

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

FULL NAME ________________________________________________________________________________

PREFERED NAME _____________________________________ BIRTHDAY _________________ AGE ______

SPONSORED BY ____________________________________________________________________________

REPRESENTING ____________________________________________________________________________

PARENTS __________________________________________________________________________________

MAILING ADDRESS_______________________________________________ CITY ______________________

STATE ________ ZIP ____________ E-MAIL ______________________________________________________

TELEPHONE _(______)_____________________ SCHOOL _____________________________GRADE ______

HOBBIES __________________________________________________________________________________

___________________________________________________________________________________________

HONORS ___________________________________________________________________________________

___________________________________________________________________________________________

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 __________________________________________________

___________________________________________________________________________________________

CURRENT TITLE ____________________________________________________________________________

Entry Fee is $125.00 & must be postmarked by 15 Oct. 2011.

Entry fee is $175.00 for at Large Contestants & must be postmarked by 15 Oct. 2011

Entries must include application, Check off sheet, signed rules, all money, photo for program with 15 words of good luck from a sponsor,

family or friends & all music CD's for Talent, Swimwear or Modeling. Applications postmarked after dealine may be accepted with a $25.00 late fee.

MY ENTRY FEE IS: _______________

One Photo with 15 words of Good Luck for the Program Division page of contestants is required at $25.00: $______________

I AM ENTERING THE FOLLOWING OPTIONALS AT $15.00 EACH!

_______ BEST ATTIRE _______ BEST PERSONALITY _______ PHOTOGENIC - AT $15.00 EXTRA FOR EACH. UP TO 4.

(OPTIONALS) = $ _______

The following competitions compete for a National Title, National Crown & National Banner in the following areas.

Competition is for ages 4-9

LITTLE NATIONAL SOUTHERN MISS MODEL QUEEN COMPETITION. $50.00 __________ OPTIONAL

(Must include Music CD with application)

LITTLE NATIONAL SOUTHERN MISS SWIMWEAR QUEEN COMPETITION. $50.00 __________ OPTIONAL

(Must include Music CD with application)

LITTLE NATIONAL SOUTHERN MISS TALENT QUEEN COMPETITION. $50.00 __________ OPTIONAL

(Must include Music CD with application)

You must be entered into all 4 competitions to be eligible for supreme.

The contestant with the highest overall all score wins Supreme and gets SUPREME added to her National Banner.

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 for the National Southern Miss Scholarship

Pageant. CONTESTANTS AGREE TO HOLD HARMLESS TODD ROWANT OWNER & NATIONAL DIRECTOR, THE NATIONAL BOARD, THE NATIONAL

SOUTHERN MISS SCHOLARSHIP PAGEANT, THE MISS FLORIDA PALM PAGEANT, The Georgia Southrn Miss Scholarship Pageant, the Miss

Georgia Palm State Scholarship Pageant, THE MISS FLORIDA COTTON PAGEANT, THE MISS ALABAMA PALM PAGEANT, THE ALABAMA

COTTON PAGEANT, THE DIRECTORS, THE VOLUNTEERS & THE PAGEANT LOCATION FROM DAMAGES NCURRED THROUGH LOSS, THEFT,

ACCIDENT OR INJURY CAUSED BY OR DURING HER PARTICIPATION IN THE PAGEANT OR ANY RELATED EVENTS. I HEREBY ACKNOWLEDGE THAT

I HAVE READ THE OFFICIAL RULES AND REGULATIONS SET FORTH BY THE NATIONAL 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 THE STATE PAGEANTS

LISTED ABOVE AND THE NATIONAL SOUTHERN MISS SCHOLARSHIP PAGEANT TO USE MY DAUGHTERS PICTURE FOR PUBLICITY AND

ADVERTISEMENT AND PURPOSES AS NEEDED .

PLEASE SIGN BELOW.

____________ ______________________________ ____________________________

DATE PARENT OR LEGAL GUARDIAN CONTESTANT

Return Signed Application to: Todd Prowant, National Director & Owner of National Southern Miss

Make Checks payable to: National Southern Miss

Send Application to: National Southern Miss c/o Todd Prowant 10177 N.W. Prowant Ln., Clarksville, FL. 32430