Empowerment Academy Signature Program Application
Name
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First Name
Last Name
Age
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Date of birth
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Mailing address
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City
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State
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Zip code
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Email
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Phone
Social media handles
Registration Fees. (You will receive an invoice for payment after application is processes and upon acceptance into program.)
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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 Signature Program Delegate?
Please describe any accommodations you may need:
Name of parent or legal guardian (if under the age of 18)
Contractual Agreement for Participation
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I have read the Contractual Agreement for Participation, and agree to abide by the rules as set forth by the Empowerment Academy.
Signature
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