Dec 10 2011 Michie, TN February 18, 2012

         Please provide the following contact information:

Sex	Male Female

   

Contestant info

Contestant's Name
Date of Birth
Age

         Address

Street Address
City
State/Province
Zip/Postal Code
Cell Phone
Home Phone
FAX
E-mail
Web site

                 MC Information

Hair Color	Blonde Brown Black Red Gray White
Eye Color	Blue Brown Black Green Gray Violet
Favorite Song
Favorite Food
Favorite Person
Favorite Pet's Name
Hobbies
School
Grade
Parents Name

      

Release

I have read and agree with all rules and regulations of GemStar Pageant Productions. I fully understand and agree that Gwen Connor, GemStar Productions, pageant staff, nor the facility assumes no responsibilities for loss of personal property, accidents, or injuries occurring at the pageant or to and from the pageant. I understand and agree there will be a $30 service fee on any returned checks, NO checks accepted 2 weeks prior to the pageant. I agree to pay all legal fees to collect any debts owed. I have read and understand all the terms of this paper work. I understand no refund will be given unless pageant is canceled or not rescheduled within 6 months. Cash only at the door/registration!