Application for
the
Miss
Coffee County Pageant
__Baby Miss, ages 0-11 Months
__ Junior Miss, ages 10 -12
__ Teeny Miss, ages 12-23 months
__ Teen Miss, ages 13-16
__Tiny Miss, ages 2-3
__ Miss, ages 17-23
__Little Miss, ages 4-6
__Petite Miss, ages 7-9
REGISTRATION FORM
___ Baby Miss, ages 0-11 months Beauty $60.00
___ Teeny Miss, ages 12-23 Months
Prettiest
Eyes $15.00
___ Tiny Miss, ages 2-3
Prettiest
Dress $15.00
___ Little Miss, ages 4-6
Prettiest Smile
$15.00
___ Petite Miss, ages 7-9 Photogenic $15.00 ad $5.00
___ Junior Miss, ages 10-12
___ Teen Miss, ages 13-16
Total________
___ Miss, ages 17-23
If received by January 3rd enter
all for 100.00
Name:________________________________________________
Address:____________________________________________
Birth date:__________________________ Age:______________
Parents:______________________________________________
Email Address:______________________________________________
Address:______________________________________________
Home Phone:________________ Cell Phone_______________
Referred by_______________________________
Contestants must have never been married or convicted of a crime. Contestant and their family
and friends agree that the judges decisions are final and not to hold the director and the pageant facility responsible for
any injuries, theft or loss before, during or after the pageant No refunds unless the pageant is canceled. There will be a
40.00 return check fee.
_________________________
_______
Contestant’s Name
Date
_______________________________
__________
Parent/Guardian Name
Date
Miss Coffee County Pageant
Ladonna Wilson
5739 Antioch church rd Willacoochee, Ga 31650
Phone: (912) 534-5509. Email: wilsonqueen@planttel.net
