Miss U.S. of America ONLINE APPLICATION CLICK ARROW TO SELECT DIVISION: BABY 0-1 TINY 2-3 LITTLE 4-8 PRE-TEEN 9-12 JUNIOR 13-15 TEEN 16-19 MISS 20-29 MRS 18-39 MS 18-39 CLASSIC MS 40+

Contestant Name:      Date of Birth: Age at time of this pageant:      Home Phone: Complete Mailing Address:                                           City:     State:      Zip Code: STATE or REGION YOU WOULD LIKE TO REPRESENT (to be printed on SASH):                                                                                              If state name is taken, we will contact you and offer a state nick-name or region Parents Names (if minor):      Email: Hobbies & Special Intrest: Ambition for Future:

SPONSORS NAMES - Will be announced during pageant and printed in program book: Where did you hear of this pageant? (mailing, advertisment, a friend, etc.) We accept CREDIT CARD Payments through PAYPAL.COM CoutoPageants@aol.com IMPORTANT THIS REGISTRATION FORM with $100 DEPOSIT SHOULD BE SENT IN IMMEDIATELY - ** SPACES ARE LIMITED! ** Upon receiving your application we will send you 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 and TINY 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 & Optional Modeling events, followed by 10 minute intermission and awards. BABY and TINY DIVISIONS are free to leave at noon or may stay to make a guest appearance at the older show later in the day. BABY & TINY SCORING: 1/3 - General Appearance                                           1/3 - Personality                                             1/3 - One Opional Competition BABY & TINY DIVISION QUEENS will each WIN: Beautiful National Crown, Sash, Trophy, Gifts, & $1000 Savings Bond! BABY & TINY OPTIONAL EVENT WINNERS will each recieve Crown, Sash, & Trophy See Rules & Regulations for complete details

SPONSORS are businesses of 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 8 sponsor names will be printed in the program book. This is a tax deduction for any business. SPONSOR ENTRY FEES BABY & TINY PAGEANT FEE  (This includes State Crown, Sash & One Optional) TOTAL PAGEANT FEE (for ages 4+)  (This includes State Crown, Sash, One Optional & Dinner) Application FEE (for all divisions)  OPTIONALS - Please type the word FREE into the first box to indicate which optional you wish as your free optional MODELING - $50 each  TALENT - $50 each  OUTFIT OF CHOICE - $50 each  PHOTOGENIC - $50 each  TOTAL  DEPOSIT ENCLOSED - $100 ** REMAING BALANCE AND PHOTO TO BE PRINTED IN OFFICIAL PROGRAM BOOK WILL BE DUE LATER! -Photo can be color or black & white, and any size 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 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 contestant is under 18 yrs. Parent Signature                                                   Date Contestant Signature                                             Date