2009 Queens for C.A.R.E. Participant Registration Form

(Cancer Awareness Reaching Everyone)

(please print/type & mail)

Contestant #________(please leave blank)                                      Age Division________

Prettiest Eyes__  Prettiest Dress__  Prettiest Smile__  Prettiest Hair__

Most Photogenic #___  (Bring a photo(s) 5x7 or 8x10 unframed the day of the pageant, $5.00/entry)

T shirt size  __YS  __YM  __YL  __AS  __AM  __AL  __AXL  __AXXL

Infant – Petite age division should order a shirt to fit the adult that will be escorting them on stage

Name_______________________                                              Age day of pageant_____

                                                                                                                                                Birth Date___________

Address_______________________________________________________

City_____________________________State_____Zip__________________

Home Phone_______________Other Phone___________________________

Email Address__________________________________________________

Sponsored by___________________________________________________

School/Employment______________________________________________

Hobbies/Interests________________________________________________

List anyone (if any) you know that have/are battled cancer and what type

1._________________________

2._________________________

3._________________________

The pageant staff, Lakeshore Mall, Relay for Life, and American Cancer Society are not liable for any loss, accident, or injury that may occur before, during, or after this event.  Photos taken during the event may be used for advertising purposes.  Contestants who provide false information on this application will be disqualified. Any un-sportsman like conduct from participants or spectators will not be tolerated.  This activity is to be in good spirit for those who are in the battle of their lives. We are performing in their honor and will act accordingly. Refunds will not be provided for any reason as all money is for charity and is tax deductible.

I have read and understand the above statement.

Signature of particitant________________________________date_______

Parent or Guardian if under 18___________________________

Registration Check List

__Registration form

__Entry Fee $55.00 before 4/18, $75.00 after 4/19 & before 5/01

__Optional Contest fees, how many____X $5.00=______ circle (eyes,hair,dress,smile,photo)

__Optional Supreme Queen Contest, call for raffle tickets

MAIL TO:                                                     QUESTIONS:

Relay for Life                                                  Teri Lynn Brock  770-490-2125

Queens for C.A.R.E. Pageant                                   Email :  TLTBHOME@aol.com

C/O Teri Lynn Brock                                           WEBSITE: www.hallcountyqueensforCARE.com

P.O. Box 908416                                              

Gainesville, GA 30501