2016 Star City Pride Mr. and Miss Pageant

APPLICATION FORM

 

Saturday, June 11, 2016

The Alley 1031 M St. Lincoln, NE  68503

Contact Information
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Visa MasterCard American Express Discover
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/
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? Visa®, Mastercard®, and Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Entry fee of $25.00 is due by June 4, 2016.

$10.00 extra will be added for late entry. Late entries will be accepted no later than bar close on Wednesday, June 8, 2016.

 

Visit www.starcitypride.org for more information and requirements.

 

Thank you for your participation!

 

OFFICE USE ONLY:

   

Date Received:   _____________________________  

 

Form of Payment:  ____________________________

 

Date Given to Pageant Coordinator:  _____________

 

 

Pageant Coordinator Signature (Sheza Mann):  _____________________________________               

Date:  ________________