Miss US of America Application

Contestant Full Name

Age at time of this pageant

Select Division

Birthday

Month

Day

Year

Cell phone

Home phone

COMPLETE Mailing Address

Where did you hear about this pageant?

State or Region you would like to represent (to be printed on your sash)

If state name is taken, we will contact you and offer a state nick-name or region

Parent Name(s) if minor

Hobbies & Special Interests

Ambition for Future

SPONSOR'S NAMES - if any (will be mentioned during pageant and printed in program book)

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 4 sponsors names will be announced during the pageant. This is a tax deduction for any business.

FEES:

Baby, Tiny, and Little Pageant (This includes State Crown, Sash, Trophy, & One Optional): $295.00

TOTAL PAGEANT FEE (for ages 7+) (This includes State Crown, Sash, Trophy, & One Optional): $395.00

Application FEE: $85.00

Registration Form with at least with $75.00 Deposit MUST BE RECEIVED IN PAGEANT OFFICE BY 2 Weeks Prior to event

NOTE: If received after deadline, please ADD $20 Late Fee

PayPal Accepted: CoutoPageants@aol.com

OR MAIL A CHECK TO: Couto Pageant Productions

P.O. BOX 65, SHELTON, CT 06484

Please select your Optionals. In each category there is a "FREE OPTIONAL" option in the drop-down menu. Select this when indicating your FREE optional:

Photogenic - $60 each

Modeling - $60 each

Talent - $60 each

Outfit of Choice - $60 each

PLEASE ENTER YOUR TOTAL AMOUNT DUE INCLUDING PAGEANT FEE

TOTAL ENCLOSED TODAY

REMAINING BALANCE AND PHOTO TO BE PRINTED IN OFFICIAL PROGRAM BOOK WILL BE DUE LATER!

Photo can be emailed to us 3 weeks before the Pageant

We will accept contestants up until 15 days before the pageant.

IMPORTANT: THIS REGISTRATION FORM with $300 DEPOSIT SHOULD BE SENT IN IMMEDIATELY... SPACES ARE LIMITED!

Upon receiving your application and a $300 deposit, we will send you your State CROWN & SASH and a packet of info for pageant weekend, along with an official program book of a past pageant. We will also send information on how you can sell ADS to pay for your sponsor fees in full if you wish!!!

BABY, TINY, & LITTLE DIVISIONS will compete on Sunday Morning only. Registration is 8:00 to 9:00am (any PHOTOS must be handed in by 9:00am) SHOW starts at 10:00am with Formal Wear and followed by 15 minute intermission and awards. These 3 divisions are free to leave at noon on Sunday or may stay to make a guest appearance at the older show later in the day. Note: If these 3 age divisions wish to compete in modeling, outfit of choice, or talent they must attend the competition show on Saturday afternoon, but Photogenic photos may be handed in at Sunday morning's registration.

BABY, TINY, & LITTLE SCORING:

1/3 - General Appearance

1/3 - Personality

1/3 - One Optional Competition

Awards:

BABY, TINY, & LITTLE DIVISION QUEENS will each WIN: Beautiful National Crown, Sash, Trophy, Age Appropriate Gifts, and the High Point 0-6 will win a $500 CASH Award!

BABY, TINY, & LITTLE OPTIONAL EVENT WINNERS WILL EACH RECEIVE A CROWN, SASH, AND TROPHY

Runners-up will receive a medallion.

See Rules & Regulations for complete details

Contestant Signature & Date

I/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. I/We give Couto Pageant Productions, Inc. permission to use any photos or video portion of the pageant weekend for advertisement.

I/We affirm that all information on this form is true & correct

(Parents must sign - if contestant is under 18 years of age)