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 Beary Special
2004 West Coast
Mini National Pageant

Contestant Information

Name

Birthday      Age Group

Address

City      State     Zip

Phone

Hair      Eyes

Hobbies    

Pets

Parents

Referred by

ENTRY FEES

Grand Supreme Package
Includes Registration Fee, beauty, Interview, 1 extra event and 1 chaperone badge.
If Entered by October 20, 2004 $295
If Entered by November 6, 2004 $345
All Entries after November 6, 2004 $395
   
Mini Supreme $50
Extra Optional Events $50
Talent $50
All 3 Supremes: (or individual below) $100
   Beauty/Photogenic Supreme $50
   Novice Supreme $50
   Overall Most Beautiful $50
Side Awards $25
Overall Most Beautful in Group $25
 
Please Check all that apply:
T-Shirt                                         ProAm
Swimwear                                  Portfolio
Print Model                                 Photogenic
 
EXTRA ADMISSION $15
TOTAL $Due
DEPOSIT
(Credit cards and Paypal Accepted)
$100
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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