2010 National Southern Miss Scholarship Pageant
APPLICATION FOR: Baby 0-23 Months, TEENY AGES 2 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 29 Oct. 2009.
Entry fee is $175.00 for at Large Contestants & must be postmarked on or before 29 Oct. 2010
Entries must include all money, photos, ad pages (ready to be copied) and 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: _______________
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) = $ _______
ONE $100.00 (Mandatory) GOOD LUCK AD. $ $100.00 . (Must be turned in ready to be copied)
(You will receive 1 free program, 1 free Photo CD, 1 free DVD & 1 full page ad for the program)
The following competitions compete for a National Title, National Crown & National Banner in the following areas.
Division is ages 0-9
IF COMPETING FOR LITTLENATIONAL SOUTHERN MISS SWIMWEAR QUEEN COMPETITION. $50.00 __________ OPTIONAL
(Must include Music CD with application)
IF COMPETING FOR LITTLE NATIONAL SOUTHERN MISS MODEL QUEEN COMPETITION. $50.00 __________ OPTIONAL
(Must include Music CD with application)
IF COMPETING FOR 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.
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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 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: Natinal Southern Miss
Make Checks payable to: National Southern Miss
Send Application to: National Southern Miss 10126 N.W. Prowant Ln., Clarksville, FL. 32430
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