Contact Information

Your First Name
Last Name
Contact Phone #
Address
City
State
Zip Code
Email
Competing Year 2010 or 2011

Physical Profile

Built:            Slim Medium Full

Hair Color:  Black Blonde Brown Other

Eyes Color: Brown Blue Other

            Sex: Female Other 

Height

Age   Grade Level

What interest you about this competition

Are you physically able to travel if required Yes No

Have you contested before Yes NO

If yes give brief detail:

 

What is your talent:    

     Please print and sign

Contestant Signature:                     

Parent / Legal Guidance  Signature:

Credit Card payment submit your application with payment and bring signed copy to the event to compete.

Check payment send your application and check to Mary-Jay health Foundation, 16541 Redmond Way ste 302-c, Redmond, WA 98052

Note: False information may forfeit eligibility.  Application must be postmarked by listed deadline for your state with processing fee listed above.