AMERICA'S REGAL GEMS

AMERICA'S REGAL GEMS MASTER APPLICATION

CONTESTANT NAME ___________________________________________________

ADDRESS  ___________________________________________________________  

CITY/TOWN       ZIP ____________________________________________________

PHONE _______________________         E-MAIL ____________________________

D.O.B. ______________________

AGE DIVISION (CHECK ONE) Age as of date of pageant with 60 day grace period

___   0 - 3 YR    ___   4 - 8 YR   ___   9 & UP

SAVE SAVE SAVE

___  $150 SUPREME PACKAGE    (Beauty and 2 events needed for Diamond Supreme title)   

CHECK  EVENTS ENTERING

____ OOC 1    ____  Swimwear    ____ Natural Photogenic      ____Talent

ADDITIONAL NATURAL PHOTOGENIC _____  @  $20

ADDITIONAL TALENT  (One only)                                                                     $25

ADMISSION TICKETS SOLD AT DOOR: Adults $20, children 12 & over - $10.

                                                      SUBTOTAL   $________

Referral,  Sibling Discounts or Preliminary Credits  $________

(You may take highest credit earned only)

                                                                   TOTAL CREDIT  $________

LATE FEE   $50   $________

(If applications received after August 10, 2011)

                   TOTAL   $________

DEPOSIT     $75   $________

(Non-refundable minimum of $75.00. Check, Money order or Paypal accepted.  A $25 fee will be charged for any returned checks.)

BALANCE DUE AT REGISTRATION $________

(CASH ONLY AT REGISTRATION)

IF STAYING AT THE HOTEL  _____  NO. OF NIGHTS   _____ NO. OF ROOMS

REFERRED BY ______________________________

LINE UP PREFERENCE  _____  FIRST     _____  MIDDLE      _____  LAST

ENTERING MOM PAGEANT  ___      ENTERING DAD PAGEANT ___

America's Regal Gems, the hotel and any of our affiliates are NOT responsible for any injuries or losses incurred during or traveling
to or from our events. All judges decisions are FINAL. Contestants and their families WILL conduct themselves in a mannerly fashion
at all times. Displays of poor sportsmanship will NOT be tolerated and may result in disqualification of contestant.

Entry fees are NON-REFUNDABLE.  By signing this application you give America's Regal Gems the right to use your name and
pictures for publicity purposes.  You also attest that the above information is true and that you understand the rules and regulations
and you will comply with them.

        _____________________________________________           __________________

Contestant's signature Parent or Guardian if minor)                      Date

Mail application and Deposit by August 10, 2011 to:

America's Regal Gems

41 Pleasant St.

Somerset, Ma. 02726-4119                                     Go back