2009 Miss Race City USA Contestant Application

ENTRY FORM APPLICATION (Return this form only for entry)

Please check one Teen: _____ Queen: _____


Name: ______________________________________________________________________
Age: __________ Birthday: ____________________________________________________

Parents: _____________________________________________________________________
Siblings: ______________________________________________________________________

Mailing Address: _____________________________________________________________
City: ____________________________________________________Zip:_________________

Phone Number: ______________________________________________________________
Email Address: _______________________________________________________________

Sponsored by: ____________________________________________________________________________________________________________________________________________________________

School: ______________________________________________________________________
Major/Degree (if applicable): _________________________________________________

Ambition: ____________________________________________________________________________________________________________________________________________________________

Hobbies/Interests: ____________________________________________________________
____________________________________________________________________________________________________________________________________________________________

Scholastic Honors: ____________________________________________________________
____________________________________________________________________________________________________________________________________________________________

Community Involvement: ______________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________

Deadline is April 18, 2009

Mailing Address: Mooresville-South Iredell Chamber of Commerce
149 E. Iredell Ave, PO Box 628
Mooresville, NC 28115
Phone: 704.664-3898
Fax: 704.664.2549

Make checks payable to M-SI Chamber of Commerce w/ 2009 Race City USA Scholarship Pageant in the Memo (Return Check fee $30). Age division determined by day of pageant,

Miss Race City USA Teen Princess (Ages 13-16)
Interview, Talent, Evening Gown, Physical Fitness - $125.00

Miss Race City USA (Ages 17-24)
Interview, Talent, Swimwear, Evening Gown - $125.00

Optional Competition
Photogenic ($10 per photo)*Limit 3 photos $ ________
Total Entry Fee $ _______ (Max is $155.00)


The parents or guardians of the contestant or the contestant themselves, for and in consideration of the participation in this Pageant do hereby release and forever discharge the directors and representative of the Miss Race City USA Scholarship Pageant and Mooresville – South Iredell Chamber of Commerce from any and every right, claim, or demand which may arise in our favor against said parties, on account of ordinary negligence connected with or growing out of the operation and conduct of the pageant. This release is intended to cover acts and omissions of ordinary negligence toward the contestants in this pageant and any damages, loss, theft or accidents that may occur at the pageant or in transportation to and from the pageant or appearances.

I give permission for my child’s or my picture or likeness and name to be used in press and on the pageant website for the purpose of promotion or advertising.

I understand that there will be a $30.00 Service Charge on all returned checks.

I / my child am (is) a North Carolina resident. I / my child am (is) and always have been a female. of good moral and character. I / my child have (has) never posed nude for photographs. I / my child must show good sportsmanship during the pageant.

I understand that the Judge’s decisions are final and that all entry fees are Non-Refundable, No Exceptions. The Miss Race City USA pageant committee has the right to disqualify me or revoke my title if my parents/guardian or I do not show good conduct.

By my signature, I affirm that I have read and fully understand this entire application and all information set forth within and will adhere.

Signature of Contestant or Parent/Guardian (if contestant is under the age of 18)



Sign: ________________________________________________________
Contestant (if 18 or older)

Date: _____________________________




Sign: _________________________________________________________

Parent / Guardian of Contestant
Date: _____________________________