Make your own free website on Tripod.com

Pageant Date: Please select one.
Name:  
Spell name phonetically (for M/C) 
 
Birthdate: Age:
Parents:
Mailing Address:
City: State: Zip:
Home Phone: Work:
Email:
EMCEE INFO:
Hair Color: Favorite Color:
Eye Color: Favorite Food:
Siblings: Favorite TV Show/Movie:
Pets: Hobbies:
Ambition: Best Friend:
Sponsors:

Talent/Commercial: 3.0 minute time limit. All tapes/CD’s must be cued! Be sure to bring a back-up tape for each music.

Music 1: Music 2:
Copy/Birth Certificate ~ Please Mark Appropriate Box:  
Enclosed with entry:    Will present at registration:      On file with Intl office

Consent to participate:I agree to hold harmless the Directors, staff and location of the Universal International pageant. Contestants, parents, and guests must abide by all rules and regulations set forth by Universal International. Good sportsmanship is a must at all times. We reserve the right to accept or reject any applicant. I realize that any infraction of the rules may result in disqualification. There are no refunds. I hereby grant Universal Miss the right to use any photograph. Videos or movies made during the competition or any other Universal International activity and allow them to use my name with any before mentioned, in any promotional efforts made in behalf of Universal International in this or any subsequent year. We reserve the right to divide, combine or cancel any division. You must provide your social security number for any cash prizes to be awarded. The judge’s decisions are final.

Signature of Parent or Guardian:
Date:


FEES
(Please note - this form does not calculate fees. Simply complete the form by entering the correct value in each of the boxes.)

Send completed forms, deposits, and Cover/Back Cover or Centerfold entries ahead of the pageant. Photos may be sent by email in JPEG format or mailed.

Mailing Address: 
UMMI CA, PO BOX 3038, Napa, CA, 94558
FAX /PHONE (707) 255-7836: Mary Jean Bruce
or (925) 408-9639: Susan Honaker
Email: UMMICA@Yahoo.com,

May pay by credit card at www.paypal.com
Paypal to: honaker2@pacbell.net
Make money orders payable to either Susan Honaker or Mary Jean Bruce.
NO CHECKS EXCEPTED, NO EXCEPTIONS!
All packages INCLUDE Registration Fee, 1 Chaperone Pass & Program Book!!

 

PACKAGE A: Divisional Talent or Beauty Only $95.00

PACKAGE B: Divisional Talent and Talent Supreme

$120.00

PACKAGE C: Divisional Beauty, Glamour, Photogenic, Beauty Supreme, Cover & Centerfold.

$135.00
PACKAGE D: Divisional Beauty, Supreme Beauty, Glamour, Photogenic, Divisional Modeling, Supreme Model, Cover & Centerfold $150.00
PACKAGE E: Divisional Beauty, Divisional Talent, Glamour, Photogenic, Grand Supreme, Beauty Supreme, Talent Supreme, Cover & Centerfold $165.00
PACKAGE F: Divisional Beauty, Divisional Talent, Divisional Modeling, Glamour, Photogenic, Grand Supreme, Beauty Supreme, Talent Supreme, Model Supreme, Cover & Centerfold $185.00
EXTRA TALENT (1 MAX) $25.00
EXTRA MODEL (1 MAX) $15.00
EXTRA PHOTOS (3 MAX) @$5.00
ADD NOVICE SUPREME $20.00
ADD SWEETHEART SUPREME $20.00
Extra Adult: _____#  @  $5.00 each
Children age 4-12____# @ $3.00 each
$Due
SUBTOTAL $Due
New Contestant Referral Credit(s): MUST BE NEW to UMMI, pageant system.Refer 1-3: $15 credit per contestant. Refer 4: FREE ENTRY to ANY package! (Does not include extra talent, modeling or photos) Minus
50% Sibling Discount. Sibling with higher entry pays full price.  Minus
DEPOSIT $35.00
BALANCE DUE AT REGISTRATION $Due
CASH ONLY at registration! No checks will be accepted - NO exceptions!
Enter by 1/21/03 for the Feb 2nd pageant and 
2/10/03 for the Feb 23rd pageant for a chance to win
a free Supreme Entry to West Coast Mini-Nationals!
Entries postmarked by 1/21/03 for the Feb 2nd pageant and 
2/10/03 for the Feb 23rd pageant will be automatically
entered in this raffle!
Cover/Centerfold Entries Due by 1/27/03 for the Feb 2nd pageant 
and 2/17/03 for the Feb 23rd pageant

Referred By:


Email: ummica@yahoo.com

 

This site is brought to you by
Designs by Nicole Miller