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
----------------------------------------------------------------------------------------------------------------
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).
(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
----------------------------------------------------------------------------------------------------------------
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).