Miss U.S. of America
ONLINE APPLICATION CLICK ARROW TO SELECT DIVISION:

Contestant Name:      Date of Birth:
Age at time of this pageant:      Primary 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 Interests:
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 $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
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, & LITTLE PAGEANT FEE 
(This includes State Crown, Sash, Trophy, & One Optional)
TOTAL PAGEANT FEE (for ages 7+) 
(This includes State Crown, Sash, Trophy, & One Optional)
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 - $60 each 
TALENT - $60 each 
OUTFIT OF CHOICE - $60 each 
PHOTOGENIC - $60 each 
TOTAL 
$300 DEPOSIT SENT NOW is subtracted from total
** 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.
 
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
 
If you have TALENT and/or OUTFIT OF CHOICE MUSIC please email it to: sdsproductions@yahoo.com by the Thursday before the pageant (this deadline is important). Put contestant's NAME and TALENT or OOC in the email memo.