F5 D2: Media and Publicity Information-2016
Complete all required areas below and submit. After you close out of the form, just click on the link and it will take you back to complete your application entries. DUE before May 22, 2016
Title:
Title: without the word Miss
Your answer
First Name:
Contestants First Name and Middle name (Only if you have confirmed with CJ you will use your Middle name)
Your answer
Last Name:
Contestants Last Name
Your answer
Hometown:
Your answer
Talent
Talent (Type: vocial, dance, piano, etc; If Dance put the type of dance)
Your answer
Music Name:
Talent music selection name:
Your answer
Music emailed?
I confirm I have sent my talent selection music by email to: Pageanttracks@cableone.net ?
Platform
Platform (place the name as you wish it to appear in the program book)
Your answer
Contact?
What is the best way to contact you?
Cell Phone
What is your Cell Phone number: Your number not a parent or guardain. Type your number like this example: (xxx)-xxx-xxxx
Your answer
Email address
What is your primary email addess: (place the email address you will check regularly from May - September. )
Your answer
Scholastic Ambition?
Your answer
Scholastic Honors?
Your answer
Non-Academic Accomplishment ?
What is your Greatest Non-Academic Accomplishment ?
Your answer
2016 Cash Scholarships' Total
2016 Cash Scholarships' Total? List below the total amount of cash scholarships won in 2016?
Your answer
Overall Cash Scholarships' Total?
2016 Overall Cash Scholarships' Total? List below the total amount of cash scholarships won since you began competing, including 2016:
Your answer
In-kind Scholarships' Total?
2016 in-kind Scholarships'- Total ONLY SCHOLARSHIP? List below the total amount of cash scholarships won in 2016? In-Kind is something you receive but not in cash. Example: A college gives you a scholarship but it is not in cash.
Your answer
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