**Rehearsal will be held at The Ritz Theater, 829 N.

Davis St Jacksonville, Florida, 32202 at 1:00PM**

Legal Name: __________________________________________________________________________
Stage Name: __________________________________________________________________________
Date of Birth: ____________________

U.S. Citizen: Y or N

Titles:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Occupation(s):
_____________________________________________________________________________________
Hobbies: _____________________________________________________________________________
Sponsors:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Back up Dancers: Y or N

If Yes, Number of Dancers: ___________

Musical Selection:
_______________________/_________________________
Song/Artist

________________________________
Category

_______________________/_________________________
Song/Artist

________________________________
Category

_______________________/_________________________
Song/Artist

________________________________
Category

I also hereby release myself from rights to any videotaping (sound and/or video), photography,
recording, still camera or motion picture to Miss. International Florida F.I. Pageant Preliminary. I
understand that I have the rights to any of the recordings that I appear in/on, or the future sale
thereof. I hereby agree that my name, any photographs taken of me during the Contest may be used
for publication for promotional purpose or in any advertising Publicity. I understand that if I am
Winner or Alternate I must fulfill all obligations to contest. Should I not fulfill my obligation to Miss.
International Florida F.I. Pageant Preliminary. I understand that I must refund all money and prizes
awarded to me by the Miss. International Florida F.I. Pageant Preliminary.

_________________________________________________________
Signature (Legal Name)

___________________
Date

_________________________________________________________
Signature (Stage Name)

___________________
Date

_________________________________________________________
Witness (Legal Name)

___________________
Date