Form — ELEGANCE & ROYALTEA

FULL NAME

First Name

Last Name

date of birth

YYYY

Phone

(###)

###

####

Street address

STREET ADDRESS LINE 2

CITY

STATE/PROVINCE

ZIP/POSTAL CODE

STATE IN WHICH YOU ARE COMPETING

DIVISION IN WHICH YOU ARE COMPETING

NAME OF HIGH SCHOOL, COLLEGE OR UNIVERSITY

IF GRADUATED, PLEASE ENTER YOUR HIGHEST LEVEL OF EDUCATION

FACEBOOK

INSTAGRAM

TWITTER

MAJOR AND GPA

BIO - IN 500 WORDS OR LESS, TELL US ABOUT YOURSELF,

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HOW ARE YOU PLANNING TO PAY?

REGISTRATION IS CLOSED

the pageant entry fee is $625.00. you may pay 1 payment of $625.00 or 2 payments of $312.50. YOU WILL BE CONTACTED VIA EMAIL UPON SUBMISSION. Entry fees are non-refundable

BY SUBMITTING THIS APPLICATION, I WARRANT THAT THE INFORMATION GIVEN IN THIS FORM IS COMPLETE AND ACCURATE. I AUTHORIZE ELEGANCE AND ROYALTEA, LLC. TO MAKE ANY INQUIRIES NECESSARY IN CONNECTION WITH THIS INFORMATION. ANY FALSE INFORMATION FOUND ABOUT ME OR ANY FORM OF MISCONDUCT WILL LEAD TO THE CANCELLATION OF MY REGISTRATION AND I WILL BE DISQUALIFIED AND ASKED TO LEAVE THE COMPETITION WITHOUT BENEFIT OF REFUND.

This application applies to the miss black usa scholarship pageant for the states of texas and louisiana only