Return your completed application form, signed,
& Entry Fee ($40.00) early registration- $45.00 at the door
payable:Our Town America
Mail To:
Our Town America
**Our Town America Pageant**
6211 SW 166th Ave.
Fort Lauderdale FL,  33331
Call: (954) 749-2264
E-mail: CSPAGEANT @AOL.COM

OFFICIAL APPLICATION FORM
MISS OUR TOWN AMERICA PAGEANT
I agree to participate in the pageant at Our Town America Event, Saturday February 28, 2004 and agree to hold harmless the OUR TOWN AMERICA, it's officers, employees, volunteers, & Sportsplex from and against any suits, proceedings, actions and causes of action of any kind.  I understand and hereby consent and give  you permission to take photographs, together with any caption or descriptive material, including my name, that you may choose, for advertising publicity, or any other lawful purpose in any publication or manner.  I waive the right to inspect or approve any photographs before they are published and any lawful use to which they may be used.  I release the OUR TOWN America, its officers agents, volunteers, and employees, and Sportsplex it's officers, management's and employees of any form of debts, claims and liability of any kind arising out of, or in conjunction with the taking and use of photographs, the use of my name and the use of any caption or descriptive material there with.

__________________________________________
Contestant's Name (PRINT

__________________________________________
Parent's Signature (if contestant under 18)

__________________________________________
Date

Miss Our Town America Pageant
Official Application Form
Complete form and return to:
Our Town America
Our Town America Pageant
6211 SW 166th Ave.
Fort Lauderdale, FL 33331
Call: (954) 749-264
E-mail: CSPageant.com

_______________________________________
AGE CATEGORIES:
________________________________________
Tiny Miss Our Town America .....ages 2-4
Little Miss Our Town America ....ages5-7
Jr. Miss Our Town America.............ages 8-11
Miss Teen Our Town America..........ages 16-19
Please Print
Category: _______________________________

Name: __________________________________

Address: ________________________________

City: ___________________________________

Zip: ____________________________________

Phone: _________________________________

Age: _____________  D.O.B. _______________

Pageant Date: February 28, 2004
Complete this form front & back with
Entry Fee: $40.00 early registration - $45.00 at the door
Make Payable to: Our Town America
(NO Cash)   Check or Money Order

For Additional information call:
(954) 749-2264 - Audrey or
341-9958 #206-Nancy