Contestants Name: Address: City, State and Zip Phone number Email Address: Contestants Age and Birth Date amount being paid Payment type Paypal - $2.00 fee Check - $35 fee on returned Money Order - Postal Only Cash - must send deposit to avoid $10 door entry fee Pageant entering April 17th - Gainsville, GA May 15th - Acworth, GA Who referred you? I have read and understand that Georgia's Miss Public Safety and All Members of the staff are not responsible for personal injury, property damage, or lost items before, during, or after the pageant.  I understand that poor sportsmanship will not be tolerated and will result in disqualification. I understand that the judges' decisions are final and will not be disputed. I understand that there will be no refunds unless the pageant is cancelled. I understand that score sheets will not be handed out at the pageant.  I give Georgia's Miss Public Safety permission to use photos taken of the above contestant on their website as well as the photographer’s website. I understand that a fee of $30.00 will be charged for any returned checks. Online Electronic Signature

Now taking the stage is __________ She is __ years old and from ______ She has ______ eyes and ________ hair Her hobbies include_________________ ________.___________, and ____________ are three things that discribe her best her best quality is ____________ her favorite food includes _____________ her future plans are ______________

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pageant entry

Preliminary Deposit $25.00 Preliminary Pay in full - no outfit change $85.00 Preliminary Balance (after deposit)- no outfit change $70.00 Preliminary Pay in full - outfit change $100.00 Preliminary Balance (after deposit)- outfit change $85.00 Door optional Package $50.00 State 2010 Deposit $75.00