I want to register for:                               --Select One-- Miss Cancer, Zodiac Miss Gastonia Newcomer Miss Leo, Zodiac Miss Virgo, Zodiac Entertainer of the Year Miss Libra, Zodiac Miss Scorpio, Zodiac Miss Sagittarius, Zodiac Miss Capricorn, Zodiac Miss Aquarius, Zodiac Miss Pisces, Zodiac . 

Personal Information:

Stage Name:                              

Legal Name:                              

Address:                              

City:                             State:                            

Zip: Age:                            

Date of Birth:

Telephone:

Email Address:

Sponsors:

TALENT:  Live     Dancing

Lip Sync.     Other

PROPS: Yes  No

DANCERS/BACKUP: Yes  No

 If Yes, How many:   ---- 1 2 3 4 5 6 7 8 9 10

BACKSTAGE ASSISTANT: Yes No

Name of Assistant:

Entry fee for the Pageant must be paid prior to entering the pageant.  ALL ENTRY FEES ARE NONREFUNDABLE! No Exceptions will be made to this rule.  By clicking the "submit" button below you are entering the Pageant presented by Zodiac Entertainment and Night Owls of Gastonia.  You hereby acknowledge that you are joining this pageant as a contestant and guarantee payment of the nonrefundable pageant entry fee.  Zodiac Entertainment and Night Owls of Gastonia reserves the right to deny entry of any pageant contestant.  Should your application be denied your entry fee will be refunded to you.

By submitting this form I hereby agree to release and hold harmless Zodiac Entertainment, Night Owls of Gastonia, their agents, servants, and employees from any liabilities and/or responsibilities whatsoever associated with or arising out of my participation in the pageant and/or the title of the pageant selected above, including, but not limited to, personal injury or damage to persona property regardless of whether the loss occurred before, during, or after the pageant or any related act.

I also hereby release myself from rights to any video taping (sound and/or video), photography, still camera or motion picture of the pageant.  I understand that I have no rights to any of the recordings that I appear in/on or the future sales thereof.  I hereby agree that my name and any photographs taken of me during the contest may be used for publication or promotional purposes or in any advertising publicity.  By my submission of this form I affirm and attest that I will abide by the Rules and Regulations of the Pageant.