AMERICA'S REGAL GEMS

AMERICA'S REGAL GEMS MISS 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 - 2 YR   ____ 3 -  4 YR     ____   5 - 6 YR    ____   7- 8 YR   

____   9 - 10 YR    ____  11-12 YR     ____   13-15 YR    ____  16 & UP

LEVEL ENTERING   (Check one) ___   Level 1 ($0-$499)    ___  Level 2  ($500-$999)     ___   Level 3 ($1000 &up)  

EARLY BIRD SPECIALS PRICE REDUCED

Beauty, all events and registration $300

_____ NATURAL BEAUTY    _____ GLITZ BEAUTY

CHECK 3 EVENTS ENTERING

____ OOC 1    ____  OOC 2    ____  Swimwear    ____  Glitz Photogenic    

     ____ Natural Photogenic   ____  Composite/Series   ____  Portfolio   ____Talent

ADDITIONAL  GLITZ PHOTO                         _____  @  $20

ADDITIONAL  NATURAL PHOTO  _____  @  $20

ADDITIONAL  COMPOSITE/SERIES                   _____  @  $20

ADDITIONAL  PORTFOLIO                                 _____  @  $20

ADDITIONAL TALENT  (One only)                                                        $25

YOU MAY ENTER UP TO 15 ADDITIONAL PHOTOS FOR ONLY $100

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)

 All applications received by August 10, 2011 will have special entry into Amethyst Supreme for
a beautiful gift.  (highest combined score Beauty and either model or fashion)

                                                                   TOTAL CREDIT  $________

LATE FEE   $50   $________

(If applications received after August 10, 2011)

                   TOTAL   $________

DEPOSIT     $150   $________

(Non-refundable minimum of $150.00. Check, Money order or Paypal accepted.) (Our paypal addy is AmerRegalGems@aol.com don't  forget to add 4% for paypal)

(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