Entry Form

Miss Relay for Life Registration Form

   

 

Name: __________________________________________________________________

 

Address: ________________________________________________________________

 

Phone #: ________________________________________________________________

 

Email: __________________________________________________________________

 

Birthday: ___________________ Age as of May 1st 2012: ________________________

 

School attending: ________________________________________________________

 

Parents Names: __________________________________________________________

 

Hobbies: _______________________________________________________________

 

 

I understand that falsification of any information on my entry blank is justification for immediate disqualification, and that the decision of the pageant director is final. I also understand and agree not to hold the pageant, pageant directors, or sponsors liable in case of injury or accidents during participation at pageant events or rehearsals. Further, I also grant the Miss Relay for Life Pageant the right to use any photographs or videotapes made during and connected with the pageant, and to use my name with any of the before mentioned promotional efforts on behalf of the pageant. This constitutes the entire agreement of parties and is legally binding.

 

Parents Signature: ____________________________________________ Date: _______

 

 

Please mail registration form and $50 registration fee to:

 

Miss Relay for Life Pageant

703 South Peters Street

Garrett, IN 46738

 

Checks should be made out to: Miss Relay for Life Pageant

 

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