Miss Gay Nepo 2015

Contestant Information
Given Name: _____________________________________________________
Stage Name: _______________________________
Birth Date: _______________

Age: ________

Address: _________________________________________________________
City: _____________________
Cellphone: ____________________________
Email address: ___________________________
Sponsor(s): _______________________________________________________
Employer: _______________________________________________________
Occupation: ______________________________________________________
Hobbies: _________________________________________________________

In case of an emergency, please notify:

Relationship of person to notify, in case of an emergency:

Are there any physical disabilities, handicaps, or any other information

you think we should know in order to better help you? Yes
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so, please explain below.