StarJewel Spring Fling Entry Form

Contact Details
Email*
Phone Number*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment Information
Contestant (or parent if contestant is under 18) Signature*

By signing here you consent to the use of electronic signature and are affirming your agreement with the terms and conditions listed above. This includes understanding that StarJewel Pageants does not administer refunds under any circumstances. Clear
Payment

Please note: Your registration will NOT be received if you do not submit payment. A nonrefundable $100 deposit is required to complete registration.

Payment*

Registration PaymentA nonrefundable $100 deposit is required to complete registration. You will be invoiced for the remaining balance. Alternatively, you may choose to pay your balance in full now, if desired.

$100.00

Optionals & Overall Titles PaymentsThese can be paid for now or at a later time.

$30.00 Quantity

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Calculation
To prevent duplicate submissions, please click submit only once.

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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