Contestant Name _______________________________ DOB ________ Age Division __________
Address ___________________________________ City ______________ State _____ Zip _______
Phone ______________________ Email_________________________________
Parent(s) ___________________________________ Hair Color __________ Eye Color __________
School/Career______________________________________________________________________
Favorite food(s)____________________________________________________________________
Hobbies/Interests____________________________________________________________________
Goals/Ambitions ___________________________________________________________________
Sponsor(s)________________________________________________________________________
__________________________________________________________________________________
(Maximum of 5 sponsors listed under contestant photo, use back if additional space is needed)
Mandatory Events: Formal Wear __ Sportswear __ Interview __ Photo Roster __
Optional Events: (Check all that you plan to enter)
Contestant's Choice __ Photogenic __ Portfolio __ Print Model __ Talent __ (ages 3 & above only)
Talent type (i.e. vocal, dance, monologue, etc.) ______________________________
Talent Selection (Name of song, dance, monologue, etc.)___________________________________
Microphone ____ Yes ____ No; Microphone Stand ____ Yes ____ No; Piano ____ Yes ____ No
I understand, agree to and will abide by all Rules and Regulations as stated by 5 Star Pageant Productions and Pacific Star USA. I also agree to hold harmless 5 Star Pageant Productions, Pacific Star, the Sheraton Airport Hotel, their affiliates and/or their staff from any loss due to accident, theft, damage or injury. I also agree to show good sportsmanship at all times, and that all information submitted is true and accurate. I agree that the judges' decision is final. I agree that any and all savings bonds and the balance of all cash awards will be awarded at the 2002 National Pageant. In order to be eligible for savings bond or balance of award, I agree to make at least two documented appearances and attend the 2002 National event. Failure to comply to any of the above statements could result in the loss of any and all fees, and forfeiture of all titles and said awards.
Signature _________________________________________________________ Date ___________
(Ages 3 years through Adult)
Registration Fee (All Divisions)------------------------$50.00....................$ __________
Includes one adult weekend pass and one program book
Ages 3 Years through Adult
Mandatory Event Fee--------------------------------------$225.00..................$__________
Optional Event Fees
Contestant's Choice----------------------------------------$30.00....................$__________
Photogenic--------------------------------------------------$30.00....................$__________
Portfolio-----------------------------------------------------$30.00....................$__________
Print Model-------------------------------------------------$30.00.....................$__________
Talent--------------------------------------------------------$30.00....................$__________
If entering all five (5) events, you pay only--------------$120.00..................$__________
"2001 Space Odyssey" Pizza & Dessert Party--This is a mandatory event for each contestant and one chaperone. Contestants over the age of 18 are not required to have a chaperone. Any and all pizza and dessert tickets needed for guests, family and friends must be reserved and paid for by August 24, 2001.
Number of tickets needed ____ x $15.00 per person.................................$__________
Sub Total--------------------------------------------------------------------------$__________
Less $75.00 Deposit--------------------------------------------------------------$__________
Balance Due-----------------------------------------------------------------------$__________
Pageant Entry Deadline:The $75.00 deposit, entry form and mandatory program book picture MUST reach our office by the deadline of August 17, 2001. All deposits and fees must be submitted in the form of cashier's check, money order or sponsor/business check and made payable to "5 Star Pageant Productions". The balance of all fees are due August 24, 2001, and must be in the form of money order or cashier's check only. All deposits and fees received are non-refundable, but can be transferred for the SAME contestant to the following year's pageant.
Rules & Regulations
National Pageant Information
Official Entry Form/Fee Schedule - 3-35 months
