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 - 23 MO    ___   2yr   ___   3yr    ___  4YR     ____   5-6 YR    ____   7- 8 YR    ____   9 - 10 YR    ____  11-12 YR     ____   13-15 YR    ____  16 & UP

LEVEL ENTERING   (Check one) ___   Level 1 ($0-$249)    ___  Level 2  ($250-$499)     ___   Level 3 ($500 &up)  

SAVE SAVE SAVE

____  $395 SUPREME PACKAGE    (Beauty and 3 events)  

             ENTER by February 1, 2010   (Includes all events, registration fee and entry into ARG Amethyst Supreme)  

CHECK 3 EVENTS ENTERING

____ OOC 1    ____  OOC 2    ____  Swimwear    ____  Glitz Photogenic    

     ____ Natural Photogenic   ____  Composite/Series   ____  Portfolio   ____Talent

ADDITIONAL EVENTS    $50 EACH   (If entering after February 1, 2010)

____ OOC 1    ____  OOC 2    ____  Swimwear    ____  Glitz Photogenic    

     ____ Natural Photogenic   ____  Composite/Series   ____  Portfolio   ____Talent

ADDITIONAL  GLITZ PHOTO                         _____  @  $10

ADDITIONAL  NATURAL PHOTO  _____  @  $10

ADDITIONAL  COMPOSITE/SERIES                   _____  @  $10

ADDITIONAL  PORTFOLIO                                 _____  @  $10

ADDITIONAL TALENT  (One only)                                                        $25

         AD PAGES  SOLD  ____ @       $50 each  $ ________

(Ad pages must be paid in full by March 1, 2009 to receive credit)

        REGISTRATION FEE     (Mandatory)    $125  (If entering after February 1, 2010)

(Includes  program book picture, 1 program book  & 1 admission ticket)

ADMISSION TICKETS SOLD AT DOOR: Adults $15, children under 12- $10.

                                                      SUBTOTAL   $________

Referral,  Sibling Discounts or Preliminary Credits  $________

(You may take highest credit earned only)

Ad Page Credit  ____ @ $25 each $_______

 All applications received by February 1, 2010 will have special entry into Amethyst Supreme for
a beautiful amethyst bracelet.  (highest combined score Beauty and either model or fashion)

                                                                   TOTAL CREDIT  $________

LATE FEE   $50   $________

(If applications received after March 1, 2010)

                   TOTAL   $________

DEPOSIT     $150   $________

(Non-refundable minimum of $150.00. Check, Money order or Paypal accepted.)

(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 March 1, 2010 to:

America's Regal Gems

41 Pleasant St.

Somerset, Ma. 02726-4119                                     Go back