Submit Your Application Online

Please fill in all the blanks on the following form. Make sure all information is accurate, as on-stage information may be taken from this form.

Personal Information


Contestant Name: (full legal name)
Publicity Name:

E-mail Address: (for all correspondence)	*

Age: (as of 09/01/2012)	Date of Birth: (mm/dd/yyyy)

Current Address:
City/State/Zip:

Permanent Address:
City/State/Zip:

Telephone:	home cell

Education

General Information


Type of Talent to Be Performed:


Community Honors and Awards:


Activities and Clubs:


( the next four fields are for the Princess Program only )

Favorite School Subject:

Favorite Food:

Princess T-Shirt Size: XS (2-4) S (6-8) M (10-12) L (14-16) XL (18-20)

When I grow up, I'd like to be a/an:

Parent or Emergency Contact

Statement of Understanding


Miss & Teen Only:
I, , am submitting my application for approval. I agree to conduct myself at all times in as to not embarrass The Miss Lane County Pageant. I also understand that there are no refunds for the registration fee.
Electronic Signature: (contestant legal name)


Princess Only:
As parents of , we are submitting her application for approval. We agree to conduct ourselves at all times in a professional manner as to not embarrass our daughter or The Miss Lane County Pageant. We will ensure that our daughter will conduct herself in the proper manner at all times. We understand that this is not a competition, but one of a mentoring and learning process conducted by the Miss Lane County Pageant and agree to abide by all decisions made by the Miss Lane County Pageant relative to The Lane County Princess Program.
Electronic Signature: (parent legal name)

* - a valid e-mail address is required for this form to submit