National Southern Miss Scholarship Pageant
APPLICATION FOR JUNIOR AGES 10-12, TEEN AGES 13 TO 16; MISS AGES 17 TO 23; & Mrs. 21-up, Married, Divorced or Single Parent
(MUST SUBMIT ORIGINAL APPLICATION PLUS 4 COPIES FOR THE JUDGES)
FULL NAME ___________________________________________________________________________________
PREFERED NAME _____________________________________BIRTHDAY ____________________ AGE ______
PARENTS NAMES ______________________________SPONSORED BY _________________________________
REPRESENTING _______________________________________________________________________________
HOME MAILING ADDRESS ________________________________________CITY __________________________
STATE _______ZIP ________ E-MAIL ______________________________PHONE # (______) ________________
SCHOOL _______________________________CITY ______________________STATE ______ZIP ____________
COLLEGE ___________________________________________________CITY _____________________________
COLLEGE MAJOR _________________________________STATUS/GRADE _____________ GPA ____________
PLATFORM SPEECH SUBJECT __________________________________________________________________
ORGANIZATIONS ______________________________________________________________________________
_____________________________________________________________________________________________
HONORS _____________________________________________________________________________________
_____________________________________________________________________________________________
SPECIAL TRAINING ___________________________________________________________________________
CURRENT OCCUPATION ___________________________FAVORITE HOBBY ____________________________
PREVIOUS TITLES ____________________________________________________________________________
CURRENT TITLES _____________________________________________________________________________
FAVORITE CHARITY ____________________________________________________________________________
MY BEST ASSET AND QUALITIES ARE ____________________________________________________________
______________________________________________________________________________________________
HOW WILL YOU PROMOTE NATIONAL SOUTHERN MISS: _____________________________________________
______________________________________________________________________________________________
WHY I ENTERED THIS PAGEANT SYSTEM: _________________________________________________________
_____________________________________________________________________________________________
MY GOAL IN LIFE IS: ___________________________________________________________________________
_____________________________________________________________________________________________
ADDITIONAL INFORMATION ____________________________________________________________________
Entry Fee is $150.00 & must be postmarked by 29 Oct. 2009.
Entry fee is $200.00 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.
W
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: National Southern Miss
Make Checks payable to: National Southern Miss
Send Application to: Prowant's 10126 N.W. Prowant Ln., Clarksville, FL. 32430
Copyright © 2008-2010 National Southern Miss. All Rights Reserved.