AMERICA'S NATIONAL PAGEANT ONLINE APPLICATION CLICK ARROW TO SELECT DIVISION: BABY 0-2 TINY 3-4 LITTLE 5-6 PETITE 7-9 PRETEEN 10-12 JUNIOR 13-15 TEEN 16-19 MISS 20-29 MS 18-39 ELITE MS 40+      Glitz Natural Both

Contestant Name:      Date of Birth: Age at time of this pageant:      Home Phone: Complete Mailing Address:                                           City:     State:      Zip Code: Parents Names (if minor):      Email: Hobbies & Special Intrest: Ambition for Future:

FREE FUN PARTY WITH MUSIC, GAMES, AND PRIZES   Saturday 7-10pm   *** If you need a hotel room BOOK ASAP (203) 627-5311 ***   You do NOT need to compete in ANY Optional Events in order to WIN Pageant Titles & High Point Queen.   Where did you hear of this pageant? (mailing, advertisment, a friend, etc.)   We hereby have read and understand all the RULES & REGULATIONS set forth by the pageant and release the Directors and Staff from any and all claims for damages or for injuries we may sustain while participating in any of the pageant activities. We affirm that all information on this form is true & correct (Parents must sign - if contestant is under 18 years of age) Parent Signature                                                   Date Contestant Signature                                             Date   NOTE: Applications recieved after the 2 week deadline A $25.00 late fee may be charged. Any Questions Call: (203) 278-2639 or Email: CoutoPageants@aol.com

SPONSORS are businesses or individuals who can pay your entry fees. This may be parents, friends or businesses. Remember that you can sponsor yourself if you wish!!! Up to 5 sponsors names will be announced during the pageant. This is a tax deduction for any business. SPONSOR'S NAMES - if any (will be mentioned during pageant):   SPONSOR ENTRY FEES ONE PAGEANT - BOTH PAGEANTS - OPTIONALS PHOTOGENTIC          GLITZ - $30 each NATURAL - $30 each MODELING   GLITZ - $50 each NATURAL RUNWAY - $50 each TALENT                                  - $60 each PAIRS MODELING         - $70 per pair TOTAL TOTAL ENCLOSED   PayPal Accepted: CoutoPageants@aol.com OR MAIL A CHECK TO: America's National Pageant P.O. BOX 556, SHELTON, CT 06484   IMPORTANT Registration From with at least with $100 Deposit MUST BE RECIEVED IN PAGEANT OFFICE BY 2 Weeks Prior to event NOTE: Any Applications recieved within that 2 weeks may be subject to a 25.00 late fee