Empowerment Academy Application

Name *

First Name Last Name

Age *

Date of birth *

Mailing address *

City *

State *

Zip code *

Email *

Phone

Social media handles

Registration Fees. (You will receive an invoice for payment after application is processes and upon acceptance into program.) *

I will pay the $200 deposit, and the $150 remaining fee within 60 days. I will pay the $350 total fee.

Personal or business website

What is your highest level of education received?

List pageant systems in which you have participated:

Are you registered or have plan to register for a pageant within the next year? If so, list the name of the system and dates of the competition.

List titles and awards received:

Are you currently under a non-compete contract with another pageant system? (No worries, we can work around this!)

If you were referred to the program, please list their name here:

What are your talents (performance and non-performance)?

What are your pageant and/or life goals for the next 6-12 months?

Why do you want to become an Empowerment Academy Delegate?

Please describe any accommodations you may need:

Name of parent or legal guardian (if under the age of 18)

Contractual Agreement for Participation *

I have read the Contractual Agreement for Participation, and agree to abide by the rules as set forth by the Empowerment Academy.

Signature *

Clear