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Registration (please type or print clearly) Miss India New York Miss India USA Miss India Worldwide Year: Name: _____________________________ Residency Status: Citizen Permanent Resident Other (specify) Address: _______________________________________________________________ Telephone: Day: ______________________ Evening: ___________________________ Mobile: ______________________ Fax: ___________________________ E-Mail: ______________________ Website (if any) : ______________________ Age: _____ Date of Birth (MM/DD/YY)_____________ Birthplace:________________ Height: ___’___” Weight: (lbs.)_______ Languages spoken: ______________________ Do you need an interpreter? Yes No Father’s Name: _______________________ Mother’s Name: _____________________ Guardian’s Name: (if different from parents)___________________________________ Guardian’s Address:_______________________________________________________ Your occupation:________________________ Education: ________________________ Hobbies and Interests: (if more space is needed, please attach paper) ________________________________________________________________________ ________________________________________________________________________ Goals: __________________________________________________________________ Why do you want to participate in this pageant? ____________________________________________________________________ ____________________________________________________________________ Talent Information: YOU WILL BE ALLOWED A MAXIMUM OF THREE MINUTES TO PERFORM YOUR TALENT. THERE ARE ABSOLUTELY NO EXCEPTIONS TO THIS RULE. Describe the talent you will be performing. Please be specific: __________________________________________________________________________ __________________________________________________________________________ Special Requirements: Microphone Microphone and Podium Other (please describe) ________________________________________________________________________ I will be performing my talent to recorded music. (Please bring two copies of the professionally recorded music with your name clearly written on them. These cassettes will become the property of IFC. MAKE SURE YOUR MUSIC IS NO LONGER THAN THREE MINUTES) ___________________________________________________________________ Passport Information: Country:___________________________ Passport No.___________________________ Place of Issue: ______________________ Dates of Issue and Expiration:_____________ Health Information: Vegetarian Non-Vegetarian List any allergies we should be aware of: ______________________________________ Please list any and all handicaps that apply to you: _______________________________ Your physician’s name: ________________________ Tel:________________________ Name of Health Insurance:______________________ Policy #:____________________ References: 1.Name_____________________Relationship:__________________ Tel:________________E-Mail:________________ 2.Name_____________________Relationship:__________________ Tel:________________E-Mail:________________ Any information that was not captured in the application may be stated here: (Please use additional paper if necessary) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
I have read and agree to follow the Rules and Regulations for the pageant I wish to enter. I also certify that the information presented in this form is correct. I also understand that the IFC reserves all rights pertaining to this contest and its decision is final. Contestant’s signature:_____________________________ Date:___________________
Click here to download the form in Microsoft Word format
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