EmailMe Form - National Miss Plus America Entry Form

Name *

First Last

Date of Birth *

Age by July 1st *

Delegate Email *

Parent or Guardian Name

(Only required for delegates ages 13-17.)

Parent/Guardian Email

(Only required for delegates ages 13-17)

Shipping Address *

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

Home Phone *

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

Cell Phone *

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

Best Number To Call *

Best Time To Call *

Choose Your Age Division *

Teen: 13-17
Miss: 18-29
Ms: 30& Up
Mrs: 20 & Up, Married

Dress Size *

Shirt Size *

Pant Size *

Shoe Size *

How many people will you be bringing with you? *

Personal Web Site URL

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

Facebook URL
(No FB Fan pages please) *

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 State Title! *

Give Three Choices. A delegate can represent any state she was born in, lives in, works in, goes to school in or owns property in.

NOTE: If you live in a state with a Plus America State Pageant, you must compete in that state pageant and win to come to nationals.

Optional Competitions *

Upload Your Photo *

Upload the photo that you wish to have displayed on 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.

DVD *

Yes

I understand the Miss Plus America DVD is a required purchase and considered part of my entry fee. I understand the deadline for the order of the DVD and payment in full of the DVD is June 15, 2015.

Scores *

Yes

I understand all scores are final. I also understand scores will not be made available after the national competition.

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 C-Hearts, L.L.C., 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 regarding payment arrangements for participation. Failure to meet my 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.

Payment Deadline *

Yes

I understand the deadline for payment for all fees is June 15, 2015.