NAME___________________________________________________AGE______

BIRTH_______

PARENTS________________________________________________________________________

MAILING ADDRESS______________________________________PHONE_________________

EMAIL ADDRESS__________________________________________________

SPONSOR________________________________________________________________________

EYE COLOR:___________

HAIR COLOR__________

HEIGHT_________WEIGHT________

THREE WORDS TO DESCRIBE YOURSELF

____________ _____________ ___________

FAVORITES: COLOR_____________

FOOD_______________

TV SHOW________________

*AS THE PARENT/GUARDIAN OF________________________________,

I AGREE THE DIRECTORS, PAGEANT COMMITTEE,

TIFT THEATRE, DOWNTOWN DEVELOPMENT

AUTHORITY, OR ANY OF ITS HOLDINGS ARE NOT

TO BE HELD RESPONSIBLE FOR INJURIES, THEFT, OR

ACCIDENTS INCURRED DURING, TO OR FROM THE PAGEANT.

 I ALSO AGREE THE JUDGES DECISIONS ARE FINAL AND

ARE NOT TO BE DISPUTED. I ALSO UNDERSTAND

THAT IF I ACT IN A DISORDERLY OR

DISRESPECTFUL WAY THAT I NOR MY

CHILD WILL BE ASKED TO PARTICIPATE IN FUTURE PAGEANTS.

________________________________________________- _____________________________________________________________________________

SIGNATURE OF PARENT/LEGAL GUARDIAN

SIGNATURE OF CONTESTANT 18 AND OVER

AGE DIVISION ENTERING_____________________

PRETTIEST DRESS________________

PRETTIEST SMILE________________

PRETTIEST FACE________________

BEST PERSONALITY________________

PHOTOGENIC_______________

MISS AMBASSADOR___________

MISS HOSPITALITY__________________

TALENT AND TYPE OF TALENT________________________

NAME OF SONG______________________________________________________________________________

ALL ENTRY FEES MUST ACCOMPANY APPLICATION.

NO REFUNDS!!

DIANNE DOMINY -DIRECTOR 229-386-2681

MAIL APPLICATION AND FEES TO MISS GEORGIA PINE PAGEANT, 3005 CLOVER CIRCLE, TIFTON, GA. 31794