Entry Form for Carolina Piedmont Pageant

You may submit this application online and mail your fees to address below Or print this application and mail to address below.
You may also download this application and rules in Word Document format HERE

Age Division:   Age: Birthdate:
First Name  
Last Name
Parents/Husband:   
Phone Number: 
Mailing Address: 
City:
State: Zip:
Email:
Hair Color:
Eye Color:
Occupation (MRS./MS ONLY):
Ambition:   
Hobbies and Interests:
Favorite TV Program:
Favorite Color: 
Sponsored By:  
Referred By:
Talent Competition: 
Type of Talent:
Name of Music:
The parents or guardians of the contestant, for and in consideration of the participation in this Pageant do hereby release and forever discharge the co-directors and representative of the Miss Carolina Piedmont Pageant, and the Newton-Conover Civic and Performance Place in Newton, North Carolina, from any and every right, claim, or demand which may arise in our favor against said parties, on account of ordinary negligence connected with or growing out of the operation and conduct of the pageant. This release is intended to cover acts and omissions of ordinary negligence toward the contestants in this pageant and any damages, loss, theft or accidents that may occur at the pageant or in transportation to and from the pageant or appearances. I give permission for my child's picture or likeness and name to be used in press and on the pageant website for the purpose of promotion or advertising. I understand that there will be a $25.00 Service Charge on all returned checks. I understand that the Judge's decisions are final and that all entry fees are Non-Refundable, No Exceptions. By my signature I affirm that I have read and fully understand this entire application and all of the information set forth within and will adhere to it.
 Signature of Parent/Guardian or Mrs.( /Ms. ) Contestant
Date

**Please either mail a photo of the contestant with the entry form or email a photo for the program book**

Competitions Entered:

Beauty (required) $65.00
Most Beautiful $20.00
Photogenic $15.00
Sportswear $15.00
Swimwear $15.00
Sleepwear (Birth-4Years) $20.00
Talent (5 and up) $20.00
Number of Sponsor tickets sold
Sponsor ticket money enclosed

Total Fees Due and Enclosed

Please Check box for appropriate Method of payment: Cash: Personal Check: Business Check: Money Order:

**Entries must be postmarked no later than
April 18th 2009! 

You may also US Postage this application to:

Make checks payable to:

CAROLINA PIEDMONT PAGEANT
Post Office Box 892
Catawba, NC  28609

Please press the enter button only once! Thank you!