America's Liberty Miss & Mr
ONLINE APPLICATION SELECT ONE:

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:

DINNER PARTY   fee is - $24.00 For Children
$30.00 For Adults
All who attend will enjoy an evening of great food, friendly faces
& festive dancing with DJ Bloppers. (order tickets below)
CHILDREN - # Do not include contestants
in these numbers.
ADULTS - #
Where did you hear of this pageant?
(Mailing, advertisement, a friend, etc.)
 Please add
$25 Late Fee
if Pageant Fee
is Received After
September 12th
NOTE: You do not NEED TO COMPETE in ANY
OPTIONAL COMPETITIONS in order to
WIN Pageant of High-Point titles.
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
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
PAGEANT & DINNER PARTY -
OPTIONALS
PHOTOGENTIC - $25 each
MODELING - $50
OUTFIT OF CHOICE - $50
TALENT - $60
TOTAL ENCLOSED
We Accept Payments Through PayPal.com
COUTOPAGEANTS@AOL.COM
IMPORTANT
Registration From with $100 Deposit MUST BE RECIEVED
IN PAGEANT OFFICE BY 2 Weeks Prior to Event