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Information Sheet - For 2012 Miss Jacksonville USA Pageant Formal Name________________________________________ SS# ______________________ Name (as you wish it to appear in the program book) ____________________________________ Age now _________ Age as of 2/1/2012 _________ Date of Birth ____/____/___ (provide proof of age) Address ________________________________________________________ Apt No ________ City _____________________ "Side of Town" __________ State ______________ Zip _______ Home Phone: ____________________________ Cell Phone: ____________________________ Work Phone: ____________________________ Email: ________________________________ Height _________ Weight _________ Bust/Cup _________ Waist _________ Hips____________ Swimsuit Size ________________ Dress Size ________________ Shoe Size _________________ Hair Color ________________________________ Eye Color ______________________________ School ___________________________________________________ Year __________________ Occupation ______________________________________________________________________ Hobbies _________________________________________________________________________ Talents, If Any ___________________________________________________________________ Other Education __________________________________________________________________ Scholastic Achievements ___________________________________________________________ Clubs and Groups you belong to in school ______________________________________________ Platform or Charitable Causes you are involved in _______________________________________ Three Words that best describe you ________________, ________________, _________________ Honors and Awards _______________________________________________________________ Career Goals/Ambition _____________________________________________________________ Mother’s Name _______________________________Occupation __________________________ Address _____________________________________________ Work Phone # _______________ Fathers Name _______________________________Occupation ____________________________ Address _____________________________________________ Work Phone # _______________ Names of Siblings/Ages_____________________________________________________________ Other Pageant Titles You Have Held __________________________________________________ ALL POTENTIAL “MISS” CONTESTANTS MUST BE AT LEAST 18 AND UNDER 27 YEARS OF AGE ON FEBRUARY 1, 2012. THEIR BIRTHDAYS MUST BE BETWEEN FEBRUARY 1ST, 1985 AND FEBRUARY 1st, 1994. (SOMEONE WHOSE BIRTHDAY IS 2/1/94 WILL BE 18 ON THAT DAY IS ELIGIBLE FOR THE “MISS” PAGEANT). ________________________________________________________________________________ Signature of Contestant (acknowledging that the above information is true and correct) Date |
**Please attach a separate piece of paper if you need more space or retype this form if necessary.
Be sure to answer all questions or put N/A.