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Beary Special
2006 National Pageant

Contestant Information

Name

Birthday      Age Group

Address

City      State     Zip

Phone

Hair      Eyes

Hobbies    

Ambition

Parents

Referred by

ENTRY FEES

Registration Fee (this is mandatory regardless of winnings) INCLUDES - Registration Packet, Plaque with Picture of Mr Tim and Horse and Carriage Ride. $195
Grand Supreme Package
Includes Beauty, Photo and Interview.
If Entered by December 1, 2005 $495
If Entered After December 1, 2005 $595
If Entered After December 31, 2005 $645
   
Mini Supreme $75
Overall Beauty Supreme $75
Beauty/Photogenic Supreme $75
Novice Supreme $100
Overall Awards $150
Side Awards $55
Talent $100
Extra Optional Events $75
Please Check all that apply:
T-Shirt                                       Casual Wear
Swimwear                                    Portfolio
Print Model                                 Natural Photo 
Composite     
 
 

Admission
Everyone except contestants will be need a badge.
$30
TOTAL $Due
DEPOSIT $150
CREDITS $
BALANCE DUE $

I have read the rules and regulations of this National Pageant and fully understand and agree to abide by them. I hereby release the staff of Dixieland Dolls and Darlings and the facility where the pageant is being held from any theft, injury or loss of property, before, during and after competition. I understand that any act of bad sportsmanship will result in disqualification without refund. I agree and allow any pictures of my child to be used for promotional use.

Signature   Date



    
    

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