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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 SAVE SAVE SAVE _____ ENTER AMERICA'S REGAL GEMS BY February 1, 2009 $550 ( Receive all events, registration fee and entry into ARG Amethyst Supreme) Total savings $220 ____ $395 SUPREME PACKAGE (Beauty and 3 events)
CHECK 3 EVENTS ENTERING
____ Model ____ Fashion ____ Swimwear ____ Glitz Photogenic
____ Natural Photogenic ____ Composite ____ Portfolio ____Talent
_____ BEAUTY (Mandatory) $275
ADDITIONAL EVENTS $50 EACH (Enter by February 15, 2009 take 2 optionals FREE)
____ Model ____ Fashion ____ Swimwear ____ Glitz Photogenic
____ Natural Photogenic ____ Composite ____ Portfolio ____Talent
ADDITIONAL GLITZ PHOTO _____ @ $10
ADDITIONAL NATURAL PHOTO _____ @ $10
ADDITIONAL COMPOSITE _____ @ $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
(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 15, 2009 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 TBA)
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
NUMBER OF YEARS COMPETED AT ARG _____ 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, 2009 to:
America's Regal Gems
41 Pleasant St.
Somerset, Ma. 02726-4119 Go back
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