MISS CZECH-SLOVAK WISCONSIN QUEEN PAGEANT APPLICATION

Please type or print in black pen:

FULL NAME: _________________________________________________________________________

HOME ADDRESS: ______________________________________________________________________

TELEPHONE #_________________      EMAIL:____________________ AGE_____

BIRTH DATE _____________ HEIGHT:___________ (Helps in pairing of Little Sisters)

PARENT(S) NAME(S)__________________________________________________________

HIGH SCHOOL ATTENDED: _____________________________________________________

IF GRADUATED, WHAT YEAR? _____________

VO-TECH/COLLEGE ________________________________YEARS(S) ATTENDED ______

IF GRADUATED, WHAT YEAR? _____________

IF STILL ATTENDING SCHOOL, GIVE SCHOOL ADDRESS: ____________________________

I WOULD LIKE TO FURTHER MY EDUCATION AT: _________________________________

EXTRA CURRICULAR ACTIVITIES IN MUSIC, DRAMA, DANCING, SPORTS, ETC.

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AMBITION/GOALS _________________________________________________________________

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MY TALENT PRESENTATION WILL BE________________________________________________

I NEED THE FOLLOWING SPECIAL EQUIPMENT/SUPPORT:_____________________________

TITLE: ___________________________________________________________________________

CIRCLE TALENT DIVISION ENTERED: AMERICAN DIVISION, NATIONALITY DIVISION

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ATTACHED IS A DESCRIPTION OF MY KROJ:

CIRCLE KROJ DIVISION ENTERED:

AMERICAN DIVISION

NATIONALITY DIVISION

MY TITLE IS ____________________________________

(Title should represent location of family heritage)

WHO WOULD YOU LIKE TO ESCORT YOU ON STAGE ON SUNDAY (PARENTS/FRIEND)?

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I WOULD LIKE TO REPRESENT MY STATE AS MISS CZECH/SLOVAK BECAUSE (Continue on back side, if required.)

SOME FACTS ABOUT MYSELF FOR PUBLICITY PURPOSES: (INCLUDE HOBBIES, CLUBS, SCHOOL ACTIVITIES, HONORS, ACHIEVEMENTS.)

(Continue on back side if required)

I HEARD ABOUT THE PAGEANT FROM:________________________________________________

I HEREBY ACKNOWLEDGE THAT I HAVE READ THE OFFICIAL RULES AND REGULATIONS FOR THE MISS CZECH-SLOVAK WISCONSIN STATE PAGEANT AND AGREE TO COMPLY WITH THEM IN EVERY WAY.

CANDIDATE SIGNATURE: __________________________________________________________

DATE: ____________

I HEREBY ACKNOWLEDGE THAT I HAVE READ THE OFFICIAL RULES AND REGULATIONS FOR THE MISS CZECH-SLOVAK WISCONSIN PAGEANT AND THE GUIDELINES FOR SPONSORS AND AGREE TO COMPLY WITH THEM IN EVERY WAY.

SPONSOR(S) SIGNATURE: __________________________________________________________

DATE____________

ENCLOSED IS THE $50 ENTRY FEE FROM MY SPONSOR:_______________________________

(Special Scholarships may be available)

ENCLOSED IS A HEAD-SHOULDER PHOTO FOR A NEWSPAPER________________________

(Digital photo is desired.  Please email to vjam47@aol.com)

ENCLOSED IS MY FAMILY TREE UP TO GRANDPARENTS INDICATING MY CZECH-SLOVAK, SILESIAN OR MORAVIAN LINEAGE.