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Candidate Interest Form - Miss Fountain Valley 2023
First and last name (name as you want it listed in any print media) *
Date of Birth *
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Email *
Home Address, City and Zip code *
Cell Phone Number *
Name of School/University, Major or Degree, Date of Graduation and Degree (if applicable) *
Describe current job(s) if applicable: (note if you are applying based on your job, you must work 35 minimum hours a week in Costa Mesa, Huntington Beach or Fountain Valley).
Title of Social Impact Initiative as you want it listed in print media: *
Please describe your 90 second Talent i.e. Dance (and type of dance), Vocal, Piano, etc. *
Local Preliminary Titles previously held in Miss CA organization (if any):
I am a U.S. Citizen (by checking this I certify that I am a US citizen. Note: a copy of birth certificate or passport will be required to compete.) *
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Any questions. Please call Sandi Licata at 714-501-9616, the Director, or email at slicata@prodigy.net
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