2016 Inspiring Princess Program
Name:
Birthdate:
Age:
Address:
City:
State:
Tee Shirt Size:
Home Phone:
Zip:
Parents Names:
Contact info: Email:
Cell:
Email:
Cell:
School:
Grade/Year:
Activities, talents, hobbies:
List Modeling, Pageant, Acting, or TV experience:
I want to be Miss Virginia Inspiring Princess because:
Complete this form and return it to the address below by September 1, 2015 or email it and pay via
PayPal through our website. (add 3.5% when using PayPal)
* Only a limited number of participants
* Email your headshot color photo for the program book to: management@missvirginiausa.com
Mail this Entry Form along with $150 non-refundable fee, made payable to MISS VIRGINIA USA
You may pay via PayPal sending payment to: management@missvirginiausa.com or using the
PayPal feature on our website.
(if you pay by PayPal, add 3.5%)
Mail your forms to:
Pageant Office
22512 Clubhouse Ridge
Bristol, VA 24202
If you have questions or concerns: (276) 466-6782
Email: management@missvirginiausa.com
www.missvirginiausa.com
READ AND SIGN THE SECOND PAGE OF THIS FORM
FAX (276) 645-8440
MISS VIRGINIA USA® MISS VIRGINIA TEEN USA®
Inspiring Princess Program
2016 Miss Virginia Inspiring Princess Pageant
Participants must be 8 - 14 years of age
Miss Virginia Inspiring Princess Pageant 2016.
The Inspiring Princess Program is a dynamic two day experience unlike no other.
Opportunities, just to name a few…
 You will be mentored by former state titleholders
 Special time and photos with Miss Virginia Teen USA 2015 and Miss Virginia USA 2015
 All participants receive a tiara
 VIP Tickets for Prelim and Final Show for MISS VIRGINIA USA / MISS VIRGINIA TEEN USA
 Your Photo in the Program Book
 Official Inspiring Princess Tee Shirt
 Exclusive behind the scenes tour of the 2016 MISS VIRGINIA USA / MISS VIRGINIA TEEN USA
Competition!
 Contestants are judged in evening gown/long dress and personality as they introduce themselves and
walk the runway
 Winner receives a special tiara and sash
 Winner will attend certain appearances with Miss Virginia USA and Miss Virginia Teen USA 2015
I am of good health and moral character.
I agree to follow all rules of the Inspiring Princess Program and I release, unconditionally and forever any
claim against MISS VIRGINIA USA, MISS VIRGINIA TEEN USA, KPJ Productions, Inc., MISS UNIVERSE
L.P., LLLP, its parent and affiliated or related companies and their respective officers, directors, partners,
employees, agents and assigns, which I may have by virtue of my participation in the Inspiring Princess
Program or by any use of my name, likeness, voice, and or biography in connection with the Inspiring
Princess Program, including use in promotional and advertising material.
I understand that I can withdraw from the program at any time, but under no circumstances will I be entitled
to a refund of the production fee, and I cannot transfer to another participant any fee in part or full, that I or
my sponsor(s) have paid.
I understand that all production fees are non-refundable.
I represent and attest that I am the parent or legal guardian of the child whose name appears below.
I agree that I and my child / ward shall be bound and obligated by the terms set forth in this entry form. I
hereby release each of the parties listed above from any claim and or causes of action I may have against them
of any nature arising from this entry form application. I hereby fully and unconditionally guarantee the
performance of my child's / ward's obligations, if any.
I have read and understand the above information and agree.
Printed Name of Applicant:
Printed Name of Parent or Guardian:
Date:
Signature of Parent or Guardian:
Date: