10th ANNUAL MISS LIBERTY PAGEANT
SATURDAY, NOVEMBER 5, 2011
MAGNOLIA THEATRE, MAIN STREET, EASTMAN, GA, 31023
REHEARSAL FRIDAY 5PM UNTIL. CONTESTANTS WILL MODEL TRADITIONAL "T" PATTERN
AGE DIVISION 0-3 YRS.-----1:00 PM
AGE DIVISION 4-12 YRS.-----4:00 PM
AGE DIVISION 13 AND UP-----7:00 PM
FULL NAME_____________________________________________________________________
AGE ON 11-05-11______BIRTHDAY_____________EMAIL_______________________________
PARENTS NAME_________________________________________________________________
STREET ADDRESS_______________________________________________________________
CITY________________ZIP_______PHONE(H)________________PHONE(W)________________
BABY MISS(0-12 MONTHS)
LITTLE MISS(7-9 YRS)
WEE MISS(13-23 MONTHS)
JR. MISS (10-12 YRS.)
TINY MISS(2-3 YRS.)
TEEN MISS(13-15 YRS.)
YOUNG MISS(4-6YRS.) MISS(16-24
YRS.)
I AM ENTERING
BEAUTY (REQUIRED)($50)______
PRETTIEST DRESS($10)_______
PHOTOGENIC ($10)__________
PRETTIEST EYES($10)________
PRETTIEST SMILE ($10)________
PRETTIEST HAIR($10)_________
EARLY BIRD SUPREME PACKAGE DUE BY ( 10/29/11 )-----$85_________
PLEASE MAKE CHECKS OR MONEY ORDER PAYABLE TO MISS LIBERTY PAGEANT. YOU CAN MAIL
TO P.O. BOX 1051 EASTMAN, GA.31023. FOR ADDTIONAL INFORMATION CALL (478) 689-0495 or (478)290-5513 OR (478)231-0673 OR
EMAIL: ms.libertypageant@yahoo.com OR WEB SITE: mslibertypageant.tripod.com. TROPHIES AND CROWNS WILL BE AWARDED TO EACH DIVISION.
THERE WILL BE GIFT BAGS FOR ALL CONTESTANTS. PEOPLE CHOICE AWARD $1.00 EACH (CONTESTANT IN EACH DIVISION
WITH THE MOST MONEY WINS A TROPHY.)
INFORMATION CONTAINED ON THIS FORM WILL BE USED WHILE CONTESTANT IS ON STAGE:
GRADE IN SCHOOL______SCHOOL_______________________________________________
HAIR COLOR________EYE COLOR____________MY HERO______________________________
FAVORITE TV SHOW_______________________FAVORITE FOOD_________________________
HOBBIES/ACTIVITIES/INTEREST____________________________________________________
______________________________________________________________________________
ACOMPLISHMENTS______________________________________________________________
______________________________________________________________________________
I AGREE THAT THE PAGEANT DIRECTOR(S), COMMITTEE AND FACILITY ARE NOT RESPONSIBLE FOR ANY LOST
OR STOLEN ITEMS OR RESPONSIBILE FOR ANY ACCIDENTS THAT OCCOUR AT OR ON THE WAY FROM THE ABOVE ACTIVITY. I ALSO RELEASE ALL
RIGHTS TO PHOTOS TAKEN DURING THE PAGEANT SO THEY MAY BE USED AS ADVERTISING PURPOSES. ALL JUDGES DECISIONS ARE FINAL APPROPRIATE
BEHAVIOR IS REQUIRED AT ALL TIMES BY PARENTS AND CONTESTANTS OR CONTESTANT WILL BE DISQUALIFIED FROM COMPETEING.THERE
WILL BE A $50.00 CHECK FEE FOR ALL RETURNED CHECKS.
TICKETS AT THE DOOR ARE $5.00 EACH EVERYONE PAYS EXCEPT
THE CONTESTANT
PARENT/GUARDIAN__________________________________DATE______________________
