EmailMe Form - 2019 California Plus America Pageant Application

Name: *

First Last

Date of Birth: *

Age You'll Be Before March 1st: *

It would be the of the same year of competing in the California Plus America Pageant

Shipping Address: *

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

Contact Email: *

Confirm

Home Phone: *

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

Cell Phone: *

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

Work Phone:

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

What's the Best Phone Contact To Reach You? *

Home

Cell

Work

Any

Best Time To Contact You: *

Choose Your Age Division:

Mrs.: Ages 20 & Up & must be married
Ms. Ages 30 & Up
Miss: Ages 18-29

Dress Size: *

Shirt Size: *

Shoe Size: *

Personal Website Url:

Facebook Url:

***You MUST have a Facebook account. If you do not have a Facebook account, you must create one***
*Content from Facebook will be reviewed prior to approval of application.

Twitter Url:

***Content will be reviewed prior to approval of application***

Your Platform of Choice: *

What cause, charity or organization will your represent as a local titleholder?

Official Charity Website:

The Url of the Charity or Organization You Represent

Choose Your Local Title!
Give three choices for your title: *

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.
Example: You live in Los Angeles and you're competing in the Ms. Division, you choose "Ms. Los Angeles"; "Ms. Hollywood", "Ms. Beverly Hills".
If someone else in Ms. has applied before you and has "Ms. Los Angeles", you would need to choose between the two remaining titles.

Optionals Competition: *

Talent

Runway

Dramatic/Humorous Dialogue

Photogenic

Cover Girl

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'

Photo Upload

Declare Any 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.

Entry Requirements & Guidelines: *

Yes

I have read and understand the entry Requirements & Guidelines.

Size Requirement: *

Yes

You must attest that you meet the size requirements as stipulated in Requirements & Guidelines.

Model Release: *

Yes

I give the Miss California Plus America Pageant permission to use my likeness for the purposes of promotion of the state 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. i also understand that there are NO REFUNDS.

Please list any prescribed medications you are currently taking:

Please list any health issues or medical conditions: