EmailMe Form - Illinois Plus America Entry Form

Name *

First Last

Date of Birth *

Age by July 1st *

Shipping Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Home Phone *

### - ### - ####

Cell Phone *

### - ### - ####

Best Number To Call *

Best Time To Call *

Choose Your Age Division *

Miss: 18-29
Ms: 30 & up

Dress Size *

Shirt Size *

Pant Size *

Shoe Size *

Personal Web Site URL

Content from your personal website will be reviewed prior to approval of application.

Facebook URL *

Content from Facebook will be reviewed prior to approval of application.

Twitter URL

Content fromTwitter will be reviewed prior to approval of application.

Your Platform *

What charity will your represent as a local titleholder?

Official Charity Web Site

Choose A Local Title! *

Give three choices. (Example: Miss Chicago, Ms Southern Illinois, Mrs Cook County, Springfield Teen Ambassador.) You get to choose the city, county or area you wish to represent. We ask that you make three choices because a title that you choose may have already been taken.

Optional Competitions *

Photogenic

Covermodel

Portfolio

Fashion Runway

None

Check the box of the competition that you wish to compete in. If you do not wish to compete in an Optional competition, click 'None'.

Upload Your Photo *

Upload the photo that you wish to have displayed on the state page of the National Website!

Declare Convictions *

All prior felony convictions must be declared and entry must be approved by the Executive Board of Directors. Failure to do so will result in immediate dismissal from MPA and loss of any title or prizes awarded.

If you have never been convicted of a felony, simply type 'None' in the required field.

Code of Conduct *

Yes

I have read and understand the code of conduct. I understand that upon submission of this application, I am bound by the rules of conduct set forth by Coronet Productions on the Delegate Eligibility and Code of Conduct Page.

F.A.Q. *

Yes

I have read and understand the Frequently Asked Questions.

Refunds *

Yes

I understand there are no refunds under any circumstances.

Size Requirement *

Yes

You must attest that you meet the size requirements as stipulated in the Frequently Asked Questions section of the National Website.

Model Release *

Yes

I give Coronet Productions, and my state pageant permission to use my likeness for the purposes of promotion of the state and national Miss Plus America Pageant and myself as an official participant of my official State Miss Plus America pageant.

Payment Arrangements *

Yes

I understand I will be contacted by my state director regarding payment arrangements for participation. Failure to meet my state's payment obligations may result in my removal as a participant, at which time I will be forbidden from making any reference to an association with Miss Plus America Pageant system.