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5TH ANNUAL MISS LIBERTY SCHOLARSHIP PAGEANT SATURDAY, NOVEMBER 10, 2007

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5th ANNUAL MISS LIBERTY SCHOLARSHIP PAGEANT SATURDAY, NOVEMBER 10, 2007 STARTS AT 4 PM MAGNOLIA THEATRE MAIN STREET EASTMAN, GEORGIA 31023 REHEARSAL FRIDAY 5PM UNTIL. CONTESTANTS WILL MODEL TRADITIONAL “T” PATTERN There will be 3 Supreme Winners also an overall Ambassador Queen (highest total score) FULL NAME (FIRST, MIDDLE, LAST)__________________________________________________________________________ AGE ON 11-03-07_____________BIRTHDAY_______________________E-MAIL_______________________________________ PARENTS NAME____________________________________________________________________________________________ STREET ADDRESS___________________________________________________________________________________________ CITY__________________________ZIP_____________PHONE (H) ____________________PHONE (B) ____________________ GIRLS BABY MISS (0-12 MONTHS) JR. MISS (10-12 YEARS) WEE MISS (13-23 MONTHS) TEEN MISS (13-15 YEARS) COMPETES FOR SCHOLARSHIP TINY MISS (2-3 YEARS) MISS (16-24 YEARS) COMPETES FOR SCHOLARSHIP YOUNG MISS (4-6 YEARS) MRS. (MARRIED, DIVORCED OR WIDOWED) LITTLE MISS (7-9 YEARS) I AM ENTERING BEAUTY (REQUIRED) ($40) ______ PRETTIEST DRESS ($5) _______ PHOTOGENIC ($10) ______ PRETTIEST EYES ($5) ________ PRETTIEST SMILE ($5) ______ PRETTIEST HAIR ($5) ________ SUPREME PACKAGE ALL EVENTS $ 65_______ PLEASE MAKE CHECKS OR MONEY ORDER PAYABLE TO: MISS LIBERTY SCHOLARSHIP PAGEANT . YOU CAN DROP OFF APPLICATION AT DODGE FITNESS/ ANGIE’S SALON OR MAIL TO P.O. BOX 1051 EASTMAN, GA. 31023. FOR ADDITIONAL INFORMATION CALL PAMELA HOLDER (478) 374-1254 OR STEPHANIE WALKER (478) 448-4651 OR (478) 972-3669 OR EMAIL: ms.libertypageant@yahoo.com OR WEB SITE: libertypageant.tripod.com INFORMATION CONTAINED ON THIS FORM WILL BE USED WHILE CONTESTANT IS ON STAGE: GRADE/CLASS IN SCHOOL_________ SCHOOL_________________________________________________________________ HAIR COLOR____________EYE COLOR_______________MY HERO_______________________________________________ __________________________________________________________________________________________________________ FAVORITE TV SHOW_____________________________FAVORITE FOOD__________________________________________ HOBBIES/ ACTIVITIES/ INTEREST___________________________________________________________________________ ACOMPLISHMENTS_______________________________________________________________________________________ _________________________________________________________________________________________________________ __________________________________________________________________________________________________________ I AGREE THAT THE PAGEANT DIRECTOR(S), COMMITTEE AND FACILITY ARE NOT RESPONSIBLE FOR ANY LOST OR STOLEN ITEMS, OR RESPONSIBLE FOR ANY ACCIDENTS THAT OCCUR AT, OR ON THE WAY FROM THE ABOVE ACTIVITY. I ALSO RELEASE ALL RIGHTS TO PHOTOS TAKEN DURING THE PAGEANT SO THEY MAY BE USED AS ADVERTISING PURPOSES. ALL JUDGES’ DECISIONS ARE FINAL. NO SCORE SHEETS WILL BE GIVEN OUT. APPROPRIATE BEHAVIOR IS REQUIRED AT ALL TIMES BY PARENTS AND CONTESTANTS OR CONTESTANT WILL BE DISQUALIFIED FROM COMPETING. THERE WILL BE A $50.00 CHECK FEE FOR ALL RETURNED CHECKS. TICKETS AT THE DOOR ARE $5.00 EACH EVERYONE PAYS EXCEPT THE CONTESTANT. PARENT/GUARDIAN SIGNATURE: ____________________________________DATE:_________________________________