Miss SEGSBD Scholarship Pageant Application

* First Name

* Last Name

* Email

* Parent's First Name

* Parent's Last Name

* Phone Number

City

Zip Code

* Categories

Baby Miss (0-11 months) - $75.00

Toddler Miss (12-23 months) - $75.00

Tiny Miss (2-3 years) - $75.00

Little Miss (4-5 years) - $75.00

Petite Miss (6-7 years) - $75.00

Young Miss (8-9 years) - $75.00

Junior Miss (10-12 years) - $85.00

Teen Miss (13-16 years) - $85.00

Miss (17-21 years) - $100.00

Evening Gown, Interview & Onstage Question

Ms./Mrs. (22+) - $100.00

Evening Gown, Interview & Onstage Question

I have a sister in the pageant

NO
YES

My sister gets FREE Best Hair and Best Dress. (You must purchase Best Hair & Best Dress to receive the discount.)

Optionals

Best Dress - $10.00

Free with sister discount

Best Hair - $10.00

Free with sister discount

Petite & Young Interview - $15.00

Junior & Teen Interview - $20.00

Photogenic - $15.00

All divisions

I want more pics - $5.00

$5.00 per extra photograph

* My birthday is

* My age is

* My grade level is

* My hair color is

* My eye color is

* I go to school at

* My hobbies are

* My most memorable moment is

* My future goals are

* I participate in these school/community activities

I, the parent or gaurdian of the contestant, and the contestant acknowledge that I have received, read and agree to the Miss SEGSBD Scholarship Pageant Rules. I also understand that Lyons Main Street, it's Director and Board of Directors, Miss SEGSBD Scholarship Pageant Director, the City of Lyons, nor Southeastern Technical College is responsible for any lost or stolen item or injury during any time of the pageant activities. I agree to the Waiver of Liability

YES

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