Application

Age_________________________Birthdate_____________________________

Address___________________________________________________________

City____________________________________State_________Zip__________

Phone____________________________________Email___________________

Talent____________________________________________________________

Circle category: Ms. (age 30 and up), Mrs. (ages 24 and up, must be married for at least one year), Miss (ages 20-29), Miss Petite (ages 20 and up, must be 5'5" or under), Teen Miss (ages 16-19), Junior Miss (ages 12-15), Juvenile Miss (ages 8-11), Tiny Tot Miss (ages 2-7)

Sponsorship fee is $250
payable to: Mrs Jackie M. Russo
Mail to: HIAB PA Pageant Director
920 - 37th Street
Altoona, PA 16601

A portion of each contestant's sponsor fees
will be donated to our pageant charity:
The Arthritis Foundation, Central PA Chapter

Signature (Parent's if under the age of 18)

_____________________________________________

I agree that I am of high moral character
and if selected as a PA State Title Winner
I will represent this pageant system with integrity and pride.

"A unique pageant for today's altruistic and elite woman of the world"