Applicants Personal Information
(Please print clearly)
Name: ____________________________________________________________________________
First Middle Last
Name of Parents: __________________________________________________
Street Address:_____________________________________________________________
City/State/Zip_________________________________________________________
Age as of
01/01/2009: _______DOB: Month:__________ Day: __________ Year:_________
(background check mandatory for contestant over the age of 18 years of age)
Home Phone: ( )_________________ Other Phone: ( )__________________
Other Phone: ( )_______________________
Email Address: ____________________@ Yahoo, AOL,HOTMAIL,[__________]other
(email address is mandatory and can be obtained free at yahoo, hotmail, or other providers)
Talent:__________________ Category:__________________