Contact Person: Ann Maciula (606-248-1810) or (606-248-0974)
Mail applications to: PO Box 836, Middlesboro, KY 40965
Email any questions to: terry.maciula@kctcs.edu
2007 Pageant Application
Name:_______________________________________________ Age: _________
Address:___________________________________________________________
City:___________________________ State: _____________ Zip: ____________
Phone: (_____)___________________ Email: ____________________________
Birthday: ______________ Grade in School:_________ Grade Average: ______
Parent/Guardian Name:______________________________________________
School, Community Activities, Awards: List activities in order of importance -- most recent and
and important first. Use outline form. Give the year of activity or award, if possible. You may list your
activities for the past 3 years. Attach one extra sheet, if needed.
_____________________________________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Talents and Hobbies, etc.:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Include a Recent 5x7 Photo of your choice
Entry Fee: $75.00 (NON-REFUNDABLE)
All entries must be received by October 2, 2007
Check-in 11:30 am, Interviews begin promptly at 12:00 noon with pageant immediately after.
Pageant to be held Saturday, October 6, 2007 at Middlesboro Central Auditorium & Festival Site
Parent/Guardian Signature (If under 18 years old): _________________________________________________
Contestant's Signature:_________________________________________________________________________
No Entries Will Be Accepted at the door
Winner receives a $1000 Scholarship to any Southeast Kentucky Community & Technical College
campus of their choice.
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