ONLINE CONTESTANT APPLICATION


Click Here for Application Instructions
Click Here to Print 2018 Contestant Application & Release Forms


Please complete each section of the application below and hit the
"Submit" button at the end. Upon completion, print the
Application Release Forms
and sign.



Please return:
*The signed Release of Liability and Financial Disclosure form
*One (1) 5 x 7 photo of yourself (color)
*Proof of age
(copy of driver's license OR passport OR birth certificate)
*Non-refundable $150.00 entry fee; Check payable to:
Ms. Senior California of America, Inc.

MAIL COMPLETE PACKET IMMEDIATELY TO ENSURE YOUR ENTRY:
Elvia Harris
4417 Benhurst Ave
San Diego CA 92122-3015

When completing the following sections, please note that NO ATTACHMENTS are allowed. All information must be included on the contestant application.


     
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CONTESTANT APPLICATION

Name:
Email Address:
Date of Birth:
Home Address:
Main Phone Number:
Home Phone Number:
Mobile Phone Number:
Work Phone Number:
Fax Number:
Marital Status:
Husband's Name:
Number of Children:
Number of Grandchildren:
Number of Great Grandchildren:
Club Memberships:
Volunteer Work/Special Interests:
Awards:
Work Experience:
Educational Background (Formal/Informal):

Description of Talent Presentation (Will you dance, sing, deliver monologue, etc.?) Please specify talent you will be sharing:

*NOTE: Changes to Talent less than 7 days before the Pageant Cannot be accepted.

Talent Background (Performance must not exceed 2 minutes and 45 seconds):

CD (If "Yes," the CD must be of good quality and have ONLY music necessary for your performance on the CD. Please bring backup CD for audio technician):

*There can be NO vocal tracks (your own voice or others) on your CD. For dancers, there can be no taps on your CD.

Yes
No

Music (title of song):

*If using a live accompanist, that person cannot be on the stage.

Composer and/or title of Broadway Show, opera, etc. from which the music originated (if applicable):
Microphone Preference (check one box): Hand-held
Standing Microphone
Props:

*Contestants are welcome to include props in their talent segment. However, all stage props must be relevant to the talent you are performing. All contestants are to provide their own props.
Displays:

Additional Requirements/Requests (Please let us know if you need tables for display of artwork, chairs to be used during talent, etc.):
Philosophy of Life (35-second on stage presentation):
Region of Pageant you are entering:

Palm Springs
San Diego
Sacramento
Orange County
Ventura County

Will you have a Sponsor? (Contestants are welcome to seek a sponsor if they wish, but this is not mandatory. The Sponsor, should they desire, could agree to pay your entry fee and/or make a general donation to the Ms. Senior California of America Pageant Program): Yes
No
Sponsor Business/Organization Name (if applicable):
Sponsor Address:
Release of Personal Information Contestant: I do hereby authorize Ms. Senior CA of America, Inc., Senior America, Inc., Ms. Senior CA Director, and CA Preliminary Pageant Directors, to disclose any information furnished by me on the Ms. Senior CA of America, Inc. Pageant(s) and Senior America, Inc., events/programs, including photos taken by Ms. Senior CA of America, Inc. and Senior America Inc., pageant photographers, video footage, for publicity purposes before, during and after the Pageant(s). Yes
No
I understand this application will be reviewed by judges of the Ms. Senior California of America Preliminary Pageants, and (if you are a finalist in a Preliminary Pageant) the judges of the Ms. Senior California of America, Inc. State Pageant. Yes
No
Your E-Signature (Print your full name to sign your electronic consent to the Release of Personal Information, Liability and Financial Disclosure):
Date:


After Submitting your form, click on "Continue" at the top of the page