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“TEEN” APPLICATION, RULES, AND REGULATIONS (Page 1) I hereby apply for entry into the MISS JACKSONVILLE TEEN USA Pageant, and the opportunity to compete in the state finals of the MISS FLORIDA TEEN USA Pageant. I understand and agree that my acceptance as a winner/finalist and my continued consideration for the title of MISS JACKSONVILLE TEEN USA is under the sole and complete discretion of my Local Pageant Director(s). I understand and agree that if selected as the winner, as one of my obligations, I will go to my host city during the time required for me to appear in the MISS FLORIDA TEEN USA Pageant. I agree to abide by all the rules of the local, state, and, national contest now in effect or as announced hereafter from time to time. I hereby agree that the site, date, time, production, manner and method of judging of the local, state, and national contests shall be solely within the discretion of my Local Pageant Directors and the decisions of the judges shall be final. I understand and agree that if I am selected as the winner, all decisions concerning production, promotion, photographs, programs, appearances, and all the others aspects of the MISS JACKSONVILLE TEEN USA Pageant(s), as well as throughout my reign, are solely at the discretion of my Local Pageant Director and Tel-Air Interests, Inc. I agree to permit my likeness, voice recording and name to be used without charge for all purposes related to the Pageants without charge in all media now known or may be known in the future. I understand that I am free to withdraw from the competition at any time, but under no circumstances will I be entitled to a refund or transfer to another contestant any fee, either full or part, that I or my sponsors have paid. There will be absolutely no exceptions to this policy. I agree that, if I am selected as the winner of my pageant, that for one year from the day of the selection my professional affairs as said winner shall be under the sole and complete management of my Local Pageant Director and that I will not give any written or verbal endorsement of any mercantile commodity or commercial or charitable organization without obtaining specific written authority from the Local Pageant Director. I agree that I will make no appearances whatsoever unless official authorization is granted by the pageant organization or its agents. I understand and agree that doing so could result in the loss of my title and return any and all prizes awarded. I agree that I will not incur, and am not authorized to incur, any debts on behalf of the MISS JACKSONVILLE TEEN USA Pageant or Tel-Air Interests, Inc. I voluntarily disclose that prior to the date of this pageant, I have not engaged in any activities, which if disclosed to the public, would bring or tend to bring, myself into disrepute, ridicule, or contempt. I acknowledge ownership of MISS JACKSONVILLE TEEN USA by TEL-AIR INTERESTS, INC., and the validity of the name MISS FLORIDA TEEN USA, and that I agree not to jeopardize such property rights in any manner whatsoever. Failure of the winning contestant to comply with any of the terms, provisions, restrictions, or obligations hereof shall, at the option of the Pageant Directors and/or TEL-AIR INTERESTS, INC., result in entrant’s disqualification, loss of title and return of any and all prizes awarded. I hereby certify that I have read this official entry form and agree to be bound by all of the rules and regulations listed. My signature and acceptance of the agreement shall constitute a binding agreement and contract between us. I understand that some prizes are awarded by Pageant Sponsors. TEL-AIR INTERESTS, INC. or the Local Pageant Director(s) will extend reasonable effort to see that Sponsors fulfill their obligations however Tel-Air and the MISS JACKSONVILLE TEEN USA Pageant assume no responsibility for the failure of the Sponsors to fulfill their commitment. The Pageant Director(s) reserve the right to award prizes/award at the conclusion of my reign if I am the winner of the competition. By the signature(s) hereon, applicant and her parents or guardian certify that they have read and understand the rules and regulations as set forth herein and that the applicant meets the requirements and will comply with the rules and regulations stated. Any untrue statement or failure to comply may result in applicant’s disqualification. Mail Application, Photo (preferably 8x10), Birth Certificate, School Identification and Registration Fee to: MISS JACKSONVILLE TEEN USA PAGEANT c/o North Florida Scholarship Organization, Inc., 817 Willow Branch Avenue, Jacksonville, FL 32205 Email: MissJacksonville@bellsouth.net // (904) 384-3578 // www.JacksonvillePageants.com *Make Check payable to “North Florida Scholarship Organization, Inc.” MISS TEEN USA, MISS USA, and MISS UNIVERSE are trademarks and service marks of MISS UNIVERSE, L.P., L.L.L.P. INITIALS _______ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - “TEEN” APPLICATION, RULES, AND REGULATIONS (Page 2) I hereby apply as an entrant in the MISS JACKSONVILLE TEEN USA Pageant (“Local Pageant”), and I acknowledge and agree as follows: 1. I will be at least fourteen (14) and but not older than eighteen (18) years of age on February 1st, 2012. 2. I am not married, have never been married, and have never had a marriage annulled. I have never given birth to a child and I am not now pregnant nor am I a parent. If any of these conditions change, I will notify my Local Director immediately, and I understand that this may affect my eligibility. 3. I have never participated in a previous national MISS TEEN USA Pageant. 4. I have not participated and will not participate in any other state’s pageant preliminary in the MISS TEEN USA pageant system this year. 5. I am of good health and moral character. 6. I am a naturally born female and a citizen of the United States. I satisfy one of the following residency and documentation requirements: (a) I now reside and have resided in my state as my permanent and primary residence for a period of at least six (6) months immediately prior to the beginning of the final competition of my state pageant (although I may have attended school, college or university elsewhere). “Permanent and primary residence” means my true, fixed and permanent domicile which I intend to make my permanent home. If I am 16 years of age or older, then to establish my compliance with these residency requirements, I am attaching photocopies of at least two (2) of the following types of documents, at least one of which must be documentation type (a) through (e): (a) my driver’s license; (b) my voter identification or registration card; (c) my resident tax return; (d) lease or deed for a dwelling in my name; (e) current school records; (f) employment documents in my name (Form W-4 and pay stubs only); (g) current telephone or utility bill in my name and (h) current bank or credit card statements in my name. If I am under 16 years of age, then to establish my compliance with the residency requirements, I am attaching my current school records, and I understand that only my current school records will be acceptable to show my residency if I am less than 16 years of age. (b) I have resided in my state as a full-time student at a college or a university for one entire semester immediately prior to the beginning of my state pageant and I am continuing to reside in my state as a full-time student (although I may have spent or be spending the summer in another state.) In order to establish my compliance with these residency requirements, I am attaching copies of my current school records. 7. I agree that if selected to represent my preliminary in the MISS FLORIDA TEEN USA Pageant I will participate in the Pageant and abide by all the rules and regulations governing that pageant. 8. Neither I nor any member of my immediate family (i.e. mother, father, sister, or brother) or anyone living in my household is currently, or has within the last two (2) years been, employed by or an officer, director or agent of any of the following. (a) NFSO, Inc., the Miss & Teen Jacksonville USA Pageant, Tel Air, or with any other company or enterprise you own or control, or of any company or enterprise under common ownership or control with you; or (b) Miss Universe, NBC Universal, Inc., NBC West, LLC, Telemundo Network Group LLC (“Telemundo”), NBC Pageants, Inc., Mr. Donald J. Trump Pageants, Inc., Trump Hotels & Casino Resorts Holdings, L.P., The Trump Organization, Ernst & Young, or, any of the subsidiaries, affiliates or related companies of the foregoing (including, without limitation, NBC Studios, Inc., any NBC and/or Telemundo owned television stations, CNBC, MSNBC, Bravo, Trio, Sci Fi, and USA). 9. I agree that if I win or succeed to the state level title or the title of MISS TEEN USA, then I will not participate in any pageants during the time that I hold either of those titles, unless authorized in writing by MISS UNIVERSE, L.P., L.L.L.P. 10. I hereby release, unconditionally and forever any claim against the Local Pageant, NFSO, Inc., Tel-Air Interests, Inc., MISS UNIVERSE L.P., L.L.L.P., its parent companies and either their respective officers, directors, partners, employees, agents, and assign, which I may have by virtue of my participation in my state pageant or by any use of my name, likeness voice, and or biography in connection with my state pageant, including use in promotional and ad advertising material. 11. I understand and agree that all issues as to eligibility shall be determined by NFSO, Inc., Tel-Air Interests, Inc. and/or MISS UNIVERSE L.P., L.L.L.P. and, I agree to abide by that determination both as to myself and other applicants. FINAL APPLICATION DEADLINE: February 6, 2011 (if this blank is not completed, see website for deadline)
__________________________________________________________________________________________ Signature of Applicant Date
__________________________________________________________________________________________ Signature of Parent or Guardian (If applicant is under (18) eighteen) Date
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