MISS CZECH-SLOVAK WISCONSINQUEEN PAGEANT APPLICATION   
                                                                                    (Link to Printable Version: Needs to be updated)
                                                                                               Please type or print in black pen:


FULL NAME:  _________________________________________________________________________


 ADDRESS:  ___________________________________City:________________________Zip:_________


TELEPHONE  #___________________________  

EMAIL:___________________________________________________ AGE________   


BIRTH  DATE _____________   HEIGHT:___________ (Helps in pairing of Little Sisters)


PARENT(S)  NAME(S)___________________________________________________________________


HIGH  SCHOOL ATTENDED:   _____________________________________________________


IF GRADUATED, WHAT YEAR? _____________


VO-TECH/COLLEGE  ______________________________________________YEARS(S)   ATTENDED ______ 
 

IF GRADUATED,   WHAT YEAR?  _____________


IF STILL ATTENDING SCHOOL, GIVE SCHOOL ADDRESS: __________________________________________

 I  WOULD LIKE TO FURTHER MY EDUCATION AT: ____________ ____________________________________


EXTRA  CURRICULAR ACTIVITIES IN MUSIC, DRAMA, DANCING, SPORTS, ETC. 
(MAY CONTINUE ON BACK SIDE)


__________________________________________________________________________________


__________________________________________________________________________________


AMBITION/GOALS  _________________________________________________________________


__________________________________________________________________________________


__________________________________________________________________________________


MY TALENT PRESENTATION WILL BE________________________________________________


I  NEED THE FOLLOWING SPECIAL  EQUIPMENT/SUPPORT:_____________________________


TALENT TITLE: ___________________________________________________________________________


CIRCLE TALENT DIVISION ENTERED: AMERICAN  DIVISION,   NATIONALITY  DIVISION  


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                             MISS CZECH-SLOVAK WISCONSIN STATE PAGEANT  APPLICATION
                                                                                                       (Part  2)
 
ATTACHED IS A DESCRIPTION OF MY KROJ:


CIRCLE KROJ DIVISION ENTERED:              
AMERICAN DIVISION                      
NATIONALITY DIVISION
 - - - - - - - - - - - - - -- -  - - - - - - - - - - - -  


MY TITLE EMBROIDERED ON MY SASH:    ____________________________________
(Title should represent location of family heritage)


 WHO  WOULD YOU LIKE TO ESCOURT YOU ON STAGE ON SUNDAY (PARENTS/FRIEND)? 
 

_______________________________________________________



I  WOULD LIKE TO REPRESENT MY STATE AS MISS CZECH/SLOVAK BECAUSE (Continue on back side, if
  required.)
 
 
 
 
SOME  FACTS ABOUT MYSELF FOR PUBLICITY PURPOSES: (INCLUDE HOBBIES, CLUBS,  SCHOOL  ACTIVITIES, HONORS, ACHIEVEMENTS.)  
(Continue on back side if required) 


 
 
 

I HEARD ABOUT THE PAGEANT FROM:_______________________________________________________________




I  HEREBY ACKNOWLEDGE THAT I HAVE READ THE OFFICIAL RULES AND REGULATIONS FOR THE  MISS CZECH-SLOVAK WISCONSIN STATE PAGEANT AND AGREE TO COMPLY WITH THEM IN EVERY  WAY.



CANDIDATE  SIGNATURE:  __________________________________________________________


DATE: ____________        




I  HEREBY ACKNOWLEDGE THAT I HAVE READ THE OFFICIAL RULES AND REGULATIONS FOR THE  MISS CZECH-SLOVAK WISCONSIN PAGEANT AND THE GUIDELINES FOR SPONSORS AND AGREE TO  COMPLY WITH THEM IN EVERY WAY.



SPONSOR(S)  SIGNATURE:  __________________________________________________________



 
DATE____________

 
ENCLOSED  IS THE $50 ENTRY FEE*  FROM MY SPONSOR:____________
                                  (*Scholarship may be available)

ENCLOSED IS HEAD -SHOULDER PHOTO FOR NEWSPAPER________________
(Digital photo is desired.  Please email to VJAM47@aol.com)

 ENCLOSED  IS MY FAMILY TREE UP TO GRANDPARENTS INDICATING MY CZECH-SLOVAK, SILESIAN OR  MORAVIAN LINEAGE. 
(Sample can be found on this link).