STEP 1:  General Information

Title I am applying for:

Teen     Miss     Ms       Mrs.    Ms Elegant     Classic Ms

Name:

Age as of August 8, 2001:

Birthdate:

Street Address:

City:

State:

Zip Code:

Country:

Telephone:

Email (valid email required):

STEP 2:  Tell us about yourself:

Tell us something about yourself:

PART 3:  Fees and Billing Information

A minimum of a $50 deposit is required to reserve your preferred title.
Your sash will be ordered once you have paid the first $200 of your sponsorship fee.  Your sponsorship fee MUST be paid in full by June 15, 2002.

Credit Card Type:

VISA      MC      AMEX      DISCOVER
No credit card - I will mail a check or money order.

Name On Card:

Card Number:

Expiration Date:

month 01 02 03 04 05 06 07 08 09 10 11 12       year 2000 2001 2002 2003 2004 2005 2006

Billing Address:

*If you are planning to pay your enrollment fees by check or money order, then print this application form and send it in along with your deposit or full payment.  Checks or money orders should be made payable to the address above.  By submitting this form I confirm that I have read, understood and agree to abide by the rules and regulations set forth by Connie Lynn Productions in the Worldwide pageant competition.  If I am under 18, I have obtained my parent permission to participate in the pageant and to use their credit card.

If all of the information is correct...   press the submit button to continue.