Name ____________________________________ Age ________________

Address ______________________________________________________

_____________________________________________________________

Phone ________________________________________________________

Connection to Mulberry __________________________________________

Parent/Guardian Name___________________________________________

I acknowledge that I have read and understand the requirements of the pageant participants and certify that I am eligible to participate in the Mulberry Sesquicentennial Pageant.

" I agree not to hold the Town of Mulberry, the Mulberry Sesquicentennial Festival committee and sponsors, the Miss Mulberry Pageant coordinators, and Mulberry Health & Retirement Community responsible for injury or loss of personal items.
" I agree to the use of my name, my picture, and any comments made by me in any publication relating to the Mulberry Sesquicentennial Festival.
" If selected to represent the Mulberry Sesquicentennial Festival as a winner of the Little Miss/Mr. Mulberry pageant, the Jr. Miss Mulberry Pageant, or the Miss Mulberry Pageant, I agree to attend all required events throughout the festival. I understand that appropriate attire and proper behavior is required at all events and therefore bad language, derogatory remarks, and smoking will not be tolerated and could result in the loss of my title.

_________________________________________ ____________________
Signature of participant or parent/guardian Date

Please submit entry forms to Mulberry Health & Retirement Community, Miss Mulberry Pageant, 502 W. Jackson St. Mulberry, IN 46058. All entries must be received by May 19, 2008. Questions regarding the pageant may be directed to Allison Meadows at 296.2911 or Jill Shambach 296.3822.