20/21 Christian Miss Registration Form

Christian Miss 20/21 National Pageant

...let your light shine before others, that they may see your good deeds and glorify your Father in heaven. ~Matthew 5:16
Contestant Information
Contestant Name *

First Name Last Name
Birth Date *

Month Day Year
Age Division (age as of September 1, 2020) See Rules & Agreement Page for explanation of difference between Miss & Ms. Divisions *

Jr. Sweetheart (ages 4-6) Sweetheart (ages 7-9) Pre-Teen (ages 10-12) Jr. Teen (ages 13-15) Teen (ages 16-18) Miss (ages 19-24) Ms. (ages 20-25)
Residency Address (This address will be used to determine your title. Be sure to read our residency requirements.) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Shipping Address (if different from above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
Participation Type (select one) *

Christian Miss Titleholder (select this option if you will compete for a national title) Exhibition Participation (select this option if you will only participate in Formal Wear presentation and/or Optional Competitions)
If you are registering as a Christian Miss Titleholder check all that apply to determine your 20/21 title

I agree with the Christian Miss Statement of Faith I participate in community or school activities regularly I attend church and participate in faith-based activities regularly I will uphold the duties outlined in the Titleholder Agreement
Parent/Guardian Information

Required for contestants ages 18 and under
Name

First Name Last Name
Home Number

Area Code Phone Number
Cell Number

Area Code Phone Number
E-mail
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in the Christian Miss National Pageant. Upon her acceptance, I assume all risks and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Christian Miss, LLC and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participation in all events.

In case of injury to said child, I hereby waive all claims against Christian Miss, LLC including all staff and affiliates, all participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Name

First Name Last Name
Fees

A mandatory $20 application fee must be paid when you submit this application. This $20 fee is in addition to the required entry fee. You may select to pay your entry fee in full or partially at this time or be sent an invoice to pay later. If you are applying as a titleholder you will be notified of your official title (based on availability) within two days of your submitting this form. Feel free to email us at contact@christianmiss.com regarding current title availability in your state prior to submitting this application. You will receive your titleholder sash and crown only after you pay your entry fee in full. Please note, your title will not be reserved without a minimum $50 deposit toward your entry fee.

We are so excited to welcome you to the Christian Miss sisterhood!

Fees

Application Fee (non-refundable) $ 20.00

Titleholder Entry Fee $ 395.00

Half Titleholder Entry Fee (you will be invoiced for remainder) $ 197.50

Titleholder Entry Fee Clergy Discount (must be verified) $ 296.25

Child 2 Titleholder Entry Fee (Sibling Discount) $ 325.00

Child 3 Titleholder Entry Fee (Sibling Discount) $ 295.00

Entry Fee $50 Deposit (Reserves your title) $ 50.00

Exhibition Participation Fee $ 260.00

Returning Titleholder Entry Fee (For those who competed in the 2019 pageant) $ 345.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty:

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Christian Miss 20/21 National Pageant