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 ______________________________________________________________________________
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HONORS _____________________________________________________________________________________
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SPECIAL TRAINING ___________________________________________________________________________
CURRENT OCCUPATION ___________________________FAVORITE HOBBY ____________________________
PREVIOUS TITLES ____________________________________________________________________________
CURRENT TITLES _____________________________________________________________________________
FAVORITE CHARITY ____________________________________________________________________________
MY BEST ASSET AND QUALITIES ARE ____________________________________________________________
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HOW WILL YOU PROMOTE NATIONAL SOUTHERN MISS: _____________________________________________
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WHY I ENTERED THIS PAGEANT SYSTEM: _________________________________________________________
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MY GOAL IN LIFE IS: ___________________________________________________________________________
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ADDITIONAL INFORMATION ____________________________________________________________________
Entry Fee is $150.00 & must be postmarked by 15 Oct. 2011.
Entry fee is $200.00 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 13-UP.
NATIONAL SOUTHERN MISS MODEL QUEEN COMPETITION. $50.00 __________ OPTIONAL
(Must include Music CD with application)
NATIONAL SOUTHERN MISS SWIMWEAR QUEEN COMPETITION. $50.00 __________ OPTIONAL
(Must include Music CD with application)
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 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
Copyright © 2008-2011 National Southern Miss. All Rights Reserved.