Age________ Date of Birth__________________________________

Mailing Address___________________________________________

________________________________________________________

E-Mail Address____________________________________________

Parents/ Guardian_________________________________________

TShirt Size:   Youth   Adult   S  M  L  XL

Phone numbers: _____________ cell ___________Home ________Work

Sponsored By_______________________________________________

I am entering: Jr. _____ Teen_____ Miss_____ Mrs

Entry Fee: ------------- $85.00 This includes beauty and mandatory Country Wear.

OPTIONALS:

I am entering Prettiest Dress _____ Fee $10.00

I am entering Prettiest Hair _____ Fee $10.00

I am entering Prettiest Smile ______Fee $10.00

I am entering Photogenic Natural _____ Fee $10.00

I am entering Photogenic Glamour ____Fee $10.00

Early Bird Special _____ Fee (see information sheet for details)

By participating in this pageant, I release The Miss GA Southern Belle Scholarship Pageant, LLC d/b/a Ga Southern Belle Pageant "Pageant" and the Director from any injury, loss or theft sustained, or resulting from my participating. I have read and fully understand the rules and regulations and do hereby release the Pageant, it’s directors and volunteers and the Colquitt County Art Center from all liabilities, including but not limited to any injury or loss or theft of property during or subsequent to the pageant. I understand that the judges decisions are final and shall not be contested. Any inappropriate behavior or poor sportsmanship will result in disqualification from the competition without refund. Only in the event that the pageant is cancelled will refunds be issued. I do hereby give permission for any or all photographs take to be used for publicity purposes.

_________________________________- Contestants Signature

_________________________________- Parent/ Guardian Signature

if contestant is under the age of 18.Make checks payable to Miss Ga. Southern Belle Pageant, include a wallet size photo, and mail with completed application to 3040 GA Hwy 133 South Moultrie, GA 31788

EMCEE SHEET

Division ______________ Contestant #______________

_____________________________________(name)

is the ________year old daughter of

_____________________________________________

From ______________________________, Georgia.

____________________________________(Name)

has ______________eyes and _________________hair.

She is in the _______grade at _____________________

(school).

Her honors include _____________________________

_____________________________________________

______________________________________________.

Her goals in life are ____________________________

_____________________________________________

______________________________________________.

Her hobbies include ___________________________

_____________________________________________

_____________________________________________.

Three words that best describe ________________

are: _______________and _________________

and __________________________.

____________________________________.