Rockbridge Regional Fair Queen C

Rockbridge Regional Fair Queen Contest Application Contestant #___

Contestant’s Name: _______________________________________________Age on 6/21/08_____DOB:__________

Home Address:___________________________________________________________________________________

Home Phone_____-_____-_____ Email:____________________________ Grade in School Sept. ’08 ____________

School Attended: __________________________________ Parent’s Name: _________________________________

Interesting Facts about Contestant: __________________________________________________________________

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Contestant’s Hobbies: _____________________________________________________________________________

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Extra Curricular Activities/Civic Groups/Church: _________________________________________________________

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Academic Achievements/Special Recognition: __________________________________________________________

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MISS CONTESTANTS ONLY: Briefly describe your platform and why it is important to you:

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I certify that all information contained on this application is true and accurate to the best of my knowledge and that I have read the rules and agree to abide by them. I release the pageant directors, pageant staff, and the Rockbridge Regional Fair from any responsibility due to the loss of personal property, illness or accident.

CONTESTANT’S SIGNATURE: ______________________________________________ Date: ______________

PARENT OR GUARDIAN SIGNATURE: ___________________________________________________________

Entry Fees: Baby Miss – $35.00 _______ All other Divisions - $45.00 ________ Photogenic - $10.00 ___________

Portfolio - $10.00 _____ Runway - $10.00 _________ Extra Photogenic - $10.00 ______

Late entry fee on all entries not postmarked by June 6, 2008 - $15.00 __________

Entries will be accepted at the Virginia Cooperative Extension office on Main Street in Lexington or may be mailed:

Miss Rockbridge Regional Fair Pageant, Attn: Kim Heslep, PO Box 117, Brownsburg, VA 24415

* Remember to attach wallet size photo for program book*