Miss Angelic Queen of America

City/State Queen Application

Name: Age: Date of Birth:

Mailing Address: City:

State: Zip Code: email:

Desired City Queen Title:

2^nd Choice City Queen Title:

State Title:

Multiple State Entries ($10.00 ea):

2^nd State:

3^rd State:

· I have read the Pilato Productions Policy Code regarding competitions.

· Signature:

· Date:

· Signature of Legal Guardian (if applicant is under the age of 18)

By signing this form, the legal guardian is granting the applicant permission to compete in the Miss Angelic Queen of America Pageant.