Registration Form

Customer Details:
Full Name*

First NameLast Name
Age Division
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Grade/School/Career:
Hobbies:
Volunteerism/Charity Work:
Future Goals/Dreams/Ambitions:
What makes you Be-YOU-tiful?
How did you hear about us?*
Other*

Please give reference of any two people whom you feel would like information about Magical Moments Pageants (if they enter the pageant, you get $50 off your pageant fees for each girl you bring to the pageant):

	Full Name	Email Address
1
2

Deposit $100.00

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