Hollywood/Southland Scholarship Competition
PRELIMINARY ENTRY FORM

The 2011 competition will be Saturday and Sunday, February 5 and 6, 2011. We will send complete entry materials to everyone who has submitted this completed form.
By submitting this entry form, you are indicating
that you have read and understand the
IMPORTANT NOTICE below.

Entrant's Name

Date of Birth (month/date/year, e.g., 02/28/89)   /     /  

Street Address

City, State

Zip Code

Daytime Phone Cell Phone (if different)

E-mail Address

Talent Description: In the space below, please describe the talent that you will perform in the talent competition.

Have you competed previously in a Miss America preliminary pageant?        
Yes        No

Have you competed in a pageant not affiliated with Miss America?        
Yes        No

Are you a citizen of the United States?        
Yes        No

How did you hear about us?

   IMPORTANT NOTICE
   A contestant's performance in the talent competition
   in limited to 90 SECONDS (1 -1/2 MINUTES).
   For the swimsuit competition, footwear IS required.

Final date for acceptance of on-line Preliminary Entry Forms for the 2011 competition is December 31, 2010. Even if you are entering another pageant, and may not be able to compete in Hollywood/Southland, you should submit a Preliminary Entry Form and other required paperwork by our deadlines to reserve your space in our pageant. Final entry deadline is January 14, 2011. No late entries accepted.