Spring Solstice 2019 Pageant Entry Form 

Contestant Information

Name:
Birth Date
Address:
E-mail:

Division Entry

Please check the division

Select:

Style Category

Please provide a brief overview of the style that you will model at the pageant

comment:*

Special Skills or Talent

Summarize the special skill or talent you will perform at the pageant.

Please indicate if you need sound equipment assistance

Comment:*

Pageant Introduction

Please write a brief introductory statement. This is a 5 sentence introduction that will be used by the Master of Ceremonies to introduce you to the judges. Please be unique.

Text area:*

Person to Notify in Case of Emergency

Name 1:
Address 2:
Cell:
-
Work Phone:
-
E-mail 2:

Image Release

Participants’ names and images will be used in a future SEDFOB magazine. The pageant will be featured on an upcoming “Living in the 21st Century” show on the Newton Community Channel. Also, some names and images will be used on the SEDFOB and Living in the 21st Century Show websites, twitter, and Youtube channel. My signature below indicates that I grant permission for my photo and images to be used freely online and during the “Living in the 21st Century” television show.
Do not publish my name, photo and/or include my image on any forms of media (i.e. television, internet, new, etc.) Please check this box.  

Checkbox:*
Signature:
Date:

Agreement

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a participant, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate disqualification.

Name (printed):*
Signatiure:
Date