Miss Royal America Pageant Application

Contestant Name:
Date of Birth:
Age at time of pageant:
Street Address:
City, State Zip:,
Phone:
Email:
Parents Names:
Hobbies & Interests:
Future Ambitions:
Sponsors are businesses or individuals who can pay your entry fees. This may be parents, friends, or businesses. Sponsor fees pay for prizes and awards, hotel facilities, pageant staff and all other expenses of producing the pageant. Remember that you can sponsor yourself if you wish!!! Up to 5 sponsor names will be printed in program book. This is a tax deduction for any businesses.
Sponsors Names:
If you are participating in talent:
Talent 1 Type: Time:
Song:
Talent 2 Type: Time:
Song:
Please provide us with a cued cassette or CD of music on Competition Day.
Where did you hear of this pageant?
Sponsor Entry Fees
Pageant & Dinner$195
Optionals
Photogenic$25 each
Modeling$40
Talent$50 each
Mother/Daughter$75
 Total
 Total Enclosed
$195 deposit is required with the application form
Form and deposit must be received 3 weeks before the pageant.
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 pageants activites. We give Couto Pageant Productions, Inc. permission to use any photos or video portion of the pageant weekend for television or publicity purposes.
We affirm that all information on this form is true and correct
Parent MUST sign if the contestant is under 18.
SignatureDate