MNUS At-Large Delegate Application

MNUS At-Large Delegate Registration
First Name:
Last Name:
E-mail
Home Phone (if none put N/A):
Cell:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Age Division:
State to Represent:
Birth Date

MonthDayYear
Age:
Photo (for identification purposes only)

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How you heard about us:
***IMPORTANT NOTE***

After registering you will be contacted by the national office for more information. If you do not respond to the emails sent or calls placed your registration will not be complete.

Please only register if you are serious about competing. If you simply want more information on MNUS and it's programs and competitions please send an email first to info@missnationalus.com.

At-large titles are first come, first serve. To secure your state title you will need to submit a $50 non-refundable registration fee after being contacted by the national office. If this is not received, your registration will not be complete.

If you have read and understand the statements above, please submit your registration.
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