Application for Miss Club Wisconsin 2010

On-Line Registration Form for qualified Contestants for Miss Club Wisconsin 2010.  The information below will be utilized for the Emcee Booklet and Pageant Program/Events. 

Contestant Handbooks can be viewed, downloaded or printed by clicking one of the links below:

MS Word - Click Here
Adobe PDF - Click Here

Registration at LaCage for contestants not pre-registered - 5:00pm
Registration at LaCage for contestants pre-registered - 6:00pm
Contestant Meeting - 6:30pm

Pay entry fees with your PayPal account or Credit/Debit card

Enter Contestant Name(s) Below- $50.00 per contestant.
Change quantity on payment page if necessary.

Online Application
Legal Name
Stage Name
Qualifying Contest
Placement
 Winner 
 1st Alternate 
 Other 
Email
Birth Date

MM		/
DD		/
YYYY
Address

Street Address

City
State

Zip Code
Country
Phone Number

###		-
###		-
####
Type of Talent
Number of Dancers
Do You Have Props?
 Yes 
 No 
Will You Need a Live Microphone?
 Yes 
 No 
Do You Need Stage Electricity?
 Yes 
 No 
Additional Needs for Talent
Gown Designer
Hair Stylist
Make-Up Artist
Jewelry Designer
Dresser's Legal Name
Sponsors/Special Thanks

By submitting my online application, I hereby agree to release and hold harmless the promoters of the Miss Club Wisconsin pageant, hereby referred to as the “Pageant”, their agents, servants, and employees, from any liabilities and/or responsibilities whatsoever from associated with or arising out of my participation in the Pageant and/or the Title of Miss Club Wisconsin 2010, including, but not limited to, personal injury or damage to personal property regardless of whether the loss occurred before, during, or after the pageant or any related act.

 I also hereby release myself from rights to any video taping (sound and/or video), photography, still camera, or motion picture of the pageant.  I understand that I have no rights to any of the recordings that I appear in/on or the future sales thereof.  I hereby agree that my name and any photographs taken of me during the Pageant may be used for publication for promotional purposes or in any advertising publicity.

I affirm and attest that I have read the Rules and Regulations and hereby agree to abide by the same.
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