Prinable Application


	I hereby apply as a delegate for the state of___________________________ in the______________________age division. Name:___________________________________________________________ Age (as of 7/22/03):_________________________________ Address:_______________________________________ Birthdate:__________________ City:_____________________ State:__________________________ Zip:_____________ Daytime Phone:_( )______________ Evening Phone:_( )________________ Occupation:___________________________________ Education:________________________________________________________________ ________________________________________________________________________ Hobbies, Talents & Special Interests:____________________________________________ ________________________________________________________________________ Volunteer & Community Involvement:______________________________________________________________ ________________________________________________________________________ Awards:__________________________________________________________________ ________________________________________________________________________ Why do you feel you should be selected as a state delegate for the 2003 Ms. American United States National Pageant®?_____________________________________________ ________________________________________________________________________ If selected as the state delegate from your state, applicant commits to participating in the 2003 Ms. American United States National Pageant®. Applicant understands that all fees are non-refundable. If crowned one of the three 2003 Ms. American United States National Queens, applicant agrees to sign a contract with Freeman Productions stating, among other stipulations, that she will make public appearances on behalf of the Ms. American United States Pageant® throughout her reign and will return to the Ms. American United States National Pageant® in the year 2003 for the purpose of crowning her successor. If applicant cannot fulfill these obligations, and is unable or unwilling to sign a contract, the title and all prizes earned will be relinquished and then presented to an alternate state delegate. Applicant holds Freeman Production harmless of any illness and/or injury incurred while participating in the Ms. American United States National Pageant® or during her reign. Applicant gives permission to Freeman Production to use state delegate's photo and/or likeness for promotional purposes. Signature of Applicant:________________________________________________ Date:__________________ Signature of Parent/Legal Guardian:______________________________________ (if under age 18) Date:__________________ Mail Entry Form, Photo & $50.00 Application Fee Payable to: Ms. NJ/PA American United States Pageant® P.O. Box 674 Hainesport , New Jersey 08036 609- 265- 0707