National paperwork

Mail all forms to: Starburst USA National *1850 O Street*Gering, NE 69341* 308-436-5722

Deadline for the form is July 6th, 2001 Forms received after that time will be subject to a $10.00 T-SHIRT FEE, with no T-shirt and we might not be able to add you into the program book. We will accept fees at the door, but we must have a reservation for a T-shirt or you will be charged the Fee and there will be no T-shirt for Interview. Please mail this form plus your deposit or entire entry fees . Remainder of the balance is due by July 06, 2001 unless other arrangements have been made.

Indicate the age that you will be July 1st by checking the appropriate group.

Girls: Baby (6-12 mths) Baby (13- 24 mths) Baby (25- 35 mths) Wee Miss (3yr - 4 yr) Tiny Miss (5yr - 6 yr) Little Miss (7 yr - 9 yr) Pre-Teen (10 yr - 13 yr) Teen (14 yr -17 yr) Miss (19+)

Name

Address City ST Zip

Age Birthdate

Parent (s)

Phone

E-mail Address

Participant T-Shirt Size: Ch SM Ch M Ch L Adult S Adult M Adult L Adult XL Adult XXL

Participant Sponsors

Business Sponsors (If applicable) – All sponsors will be listed under your name in the Participant Roster.

Dare To Dream Release Form

As the parents (legal guardian) of the participant named above at the Dare To Dream...Finals, I do hereby agree to abide by the rules and regulations, directives and provisions for winners and contestants set forth in the official Rules and Regulations. I agree to hold Starburst USA National & Dare To Dream..., its directors and staff members harmless of any damages or liabilities due to theft, accident or injury during or resulting from my child’s participation in the National Finals. I also accept the full responsibility for the regulation of hours and personal activities of the participant. I understand and agree that should an act of God (hurricane,fire, tornado, or any other natural disaster) cause the cancellation of the pageant, that said pageant will be cancelled without benefit of any refund; however, the pageant will be scheduled at another time and location. Any contestant, chaperone, and guest of the contestant displaying poor sportsmanship or inappropriate behavior shall be subject to disqualification and/or removal from the event and shall forfeit any and all claims to any entry fees, prizes and awards. No verbal or physical abuse of any kind to another contestant, judge or staff from any contestant, chaperone or guest will be tolerated. I also confirm that all of the enclosed information and forms are true and correct to the best of my knowledge and belief. I understand that any additional charges to my room during the pageant (phone calls, valet service, room service, ect) are my sole responsibility and hereby agree to pay such charges immediately upon checking out the hotel at the conclusion of the pageant. FURTHERMORE I hereby state that I have read and understood the rules and regulations governing the payment of the savings bond awards and all other prizes and awards. I also understand that if I decide to drop out of any competition/optional on my own after deadline date, will result in no refund.

Parent’s Guardian Signature Date

Mystical Masquarade Banquet and Ball

All contestants must attend the banquet and ball. We strongly urge that all guests attend with a costume, but it is not necessary. All Must wear a mask, either decorated by contestant or parent. We will have masks available for sale at registration if you did not bring one. We ask that all girls decorate their masks as there will be special prizes for the funniest, most orginal, and the most exotic and the most outrageous. The wilder the better. Must have all tickets bought by July 6th.

  All contestants & guests must pay for banquet tickets . Tickets are $15.00 ea and 3 and under are free.

Total Amount of Meal Tickets Needed X $15.00 Equals=

Guest Tickets

        All contestants have one free ticket for chaperone. All others may pay (Adult) $25.00 (Children) $10.00 for the entire weekend

Number of Adult Tickets

Number of Children Tickets

$Total Due

Advertising In Program Book

        You can become the "Dream Girl" by selling additional advertising pages in the souvenir program book…. Each ad you sell you will receive 30% toward your fee’s. If you sell over the amount of the fee’s you will receive the 30% in cash on stage Every participant has the opportunity to place one or more photos in the program book on their very own advertising pages, showing the different sides of their personality and their community involvements. In addition to the distinct honor of appearing as one of the Cover Girls, The winner will receive an official "Dare To Dream... Dream Girl Crown", banner and trophy!! (Remember , if you win the National Overall Supreme or a Divisional Title for your age division you still can win this award. All adds MUST be in the office by July 6th, after that they will not be included in the program book.

Program Book Ads

Full Page           $ 100         You will receive $ 50.00 towards fees for each ad sold

Half Page           $ 50         You will receive $ 25.00 towards fees for each ad sold

Quarter Page     $ 25.00      You will receive $ 12.50 towards fees for each ad sold

Business Card    $ 12.50      You will receive $ 6.25 towards fees for each ad sold

Referral Program-Miss Hospitality

Each contestant will have the opportunity to earn the title of Miss Hospitality. By referring contestants that enter you can earn the following prizes: First 1-4 contestants that enter will receive $10 each, 5 -9 referred contestants, you will receive Package B--Free, referr 10 or more and receive Package B plus up to $200 in Hotel fees paid. The contestants must be entered to receive this award. The contestant that referrs the most entries will receive a Crown, Embroidered Satin Sash. Please place you name on the bottom of the application that you hand out in order to get this correct referral or have contestant mention that you referred them. All other participants will receive tiaras and satin sashes.

National Pageant Fees

(Please check all the appropriate boxes below) We need Wallet size picture for the program book no later than July 6th, after that date you will not be listed in the book

July 4th Special National Price

Special Package A-$250.00 Entry Fee (Includes the following Interview, Casual Wear and Evening Gown)

Special Package B-$275.00 Mandatory plus any 4 optionals

Special Package C- $300 Mandatory plus all optionals, Model of Year and Cover Girl

To Do Both Pageants--$500 (Gives you package b only)

Must use the following if using coupons discounts ot special promotions

Package A-$350.00 Entry Fee (Includes the following Interview, Casual Wear and Evening Gown)

Package B-$435.00 Mandatory plus any 4 optionals

Package C- $510 Mandatory plus all optionals, Model of Year and Cover Girl

To Do Both Pageants--$700 (gives you package B in both only)

Additional Photos- $20 X ___= $____

$30---Mother/Father/Daughter Competition

$30--Front/Back Cover Girl

$30--Model of Year

$10--T-Shirt (Mandatory)

Please check all optionals that you are doing

Talent Sports Wear/ Pro Am PortfolioPhotogenicWestern Wear/Denim WearAngelfacePersonality (Baby Only)

I am using the sibling discount

Sibling discount please deduct 15%

Special discount authorized by Director

$ Total Amount Due

$ Subtract $100.00 Deposit is non-refundable if request is made after June 15, 2001

$ Amount Due by July 6, 2001 (unless other arrangements have been made)

$ Amount Enclosed Or to Charge to Credit Card or by paypal at( chesam@prairieweb.com)

We will allow Cahier's Checks, Money Orders. Personal checks will be allowed until June 30th only. Don't ask after that!

Charge To The Following Credit Card

Visa MasterCard

Cardholder Name

Cardholder Number Expires