ENTRY FORM & EMCEE SHEET
ENTRY DEADLINE: April 1, 2005.
Contestant
Name______________________________________
Age
___________Age Division ___________________
Address________________________________________________
City
______________________ St______ Zip __________
Phone
(_____)________________
Email
_________________________________________
DOB______________
Hair color ______________
Eye
Color _______________
Parent(s)/Spouse
__________________________________________________________________________________
School/Career
____________________________________________________________________________________
Hobbies/Interests
_________________________________________________________________________________
Goals/Ambitions
__________________________________________________________________________________
Favorite
Food(s) __________________________________________________________________________________
Favorite
Television Show or Movie ___________________________________________________________________
Favorite
Singer/Group _____________________________________________________________________________
Three
words that best describe me:
1)
____________________ 2) ____________________
3)
____________________
Sponsors
- ( a total of seven may be listed under picture in program book)
________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
By signing below, I certify that the above information is true and correct to the best of
my knowledge. I agree that I will hold harmless 5 Star Pageant Productions, the
host hotel, their affiliates, employees, and/or volunteers from any damages from any loss, while in route, during or
following said event. I agree that all savings bonds will be prorated if less than 45
total contestants. I agree to and will abide by all rules and regulations as set forth by 5 Star Pageant Productions. I agree that I/my child must compete in the age division according to age on August 1, 2005.
I agree that all savings bonds will be awarded after the 2006 Pageant, and upon a successful and completed reign. I agree that poor sportsmanship could result in the disqualification of the above
named contestant from state pageant and forfeiture of all fees that have been received.
I agree that all deposits and fees are non-refundable and non-transferable. I also agree that by entering this pageant, the above named contestant, or guardian
of the above named contestant consents to allow 5 Star Pageant Productions permission to use photos, names, or likeness
for the sole purpose of promoting and/or advertising for the Pageant System, and that prizes and awards will be deemed all
compensation due. I also agree that prizes of equal or greater value may be substituted.
I agree that the decision of the judges is final.
Signature
______________________________________________________________
(Parent
or guardian if under 18)
Date
_____________________
****************************
FEE SCHEDULE
(Mark all that apply)
Contestant Name _____________________________________________________________
Age Division __________________________
___ __ Mandatory (Age Division)
Evening Gown, Casual Wear, and Interview..... $275.00
_____ Optional Talent......$50.00
_____ Optional Photogenic.....$35.00
_____ Optional Print Model.....$35.00
_____ Optional Portfolio....$35.00
Mandatory State Interview T-Shirts
Youth $18.00 each
Size: YS(6-8)_____ YM(10-12)_____ YL(14-16)_____
Adult $22.00 each
Adult Small_____ Adult
Medium_____ Adult Large_____ Adult
Extra Large_____
All T-shirts must be ordered and prepaid at time of pageant
entry deadline.
There is no limit to the number of t-shirts ordered. No
t-shirts can be ordered after pageant entry deadline. All t-shirts will be available for pick up at registration.
Mandatory "Mexican Fiesta" Theme Dinner & Optional Awards _______ tickets @ $26.00 each...$ ______
T-Shirt Total:...............................................$______
Program Book Ads:($50.00 per page)........$______
Total fees due:.............................................$
_____
Early Bird Discount: receive
a $50.00 discount if total fees due are paid in full by March 15, 2005 $ -_____
or send Deposit: $150.00 - received by March 29, 2005
$ ______
with the Balance Due: by April 10, 2005 $
______
All fees are to be in the form of cashiers
check or money order only
Mail Entry Form, Fee Schedule,
Program Book Photo, Deposit or Total Fee to:
5
Star Pageant Productions
PO
Box 21628, Keizer, OR 97307
DIRECTORS:
Sherrie
Gottfried (503) 390-3908 & Charlotte Bail (503) 463-6319
