Miss Mardi Gras of Southeast Texas 2005

Name _________________________________________   Age Group ___________ Birthdate __________________

Address _______________________________________    Telephone # (            ) ___________________________

            _______________________________________    Email Address __________________________________

SS #     __ - __ - __    __ - __    __ - __ - __ - __                Parents _______________________________________
(For Scholarships and Savings Bonds)

Sponsored By  __________________________________________________________________________________
 
EMCEE INFORMATION  (you may attach additional info)

School
(if applicable)  ____________________________  Hair Color________________  Eye Color________________

Hobbies: _______________________________________________________________________________________

_______________________________________________________________________________________________

Awards/Recognition:  _____________________________________________________________________________

_______________________________________________________________________________________________

Future Goals: ___________________________________________________________________________________

_______________________________________________________________________________________________

Most Embarrassing Moment _______________________________________________________________________

_______________________________________________________________________________________________

What does Mardi Gras mean to you? ________________________________________________________________

_______________________________________________________________________________________________

TERMS OF AGREEMENT
I, the undersigned, do hereby agree to all Rules of Eligibility, Rules and Regulations outlined on the Official Entry Form. I understand that the
Miss Mardi Gras of Southeast Texas Pageant, Mardi Gras of Southeast Texas, Inc., nor Port Neches-Groves ISD are NOT responsible for
any or all injuries, damages, losses, theft of property, or illness incurred while participating in the Pageant or during my reign. I also give
permission to the Miss Mardi Gras of Southeast Texas Pageant to use my photo and/or likeness for promotional purposes. If I do not comply
with all Rules and Regulations defined in this contract, I will be forced to forfeit my place in the pageant.
 

____________________________________                                           ______________________________
Signature of Applicant                                                                                Date of Signature

____________________________________                                           ______________________________
Signature of Parent if under 18                                                                     Date of Signature

Include $65.00 entry fee by check or money order made out to:
T
iffany Dennis
4101 Redwood Street
Groves, TX  77619

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