Miss Southlake Westlake Registration Form

Southlake/Westlake Registration Form

Thank you for your interest in the Miss Southlake/Westlake Competition on September 8, 2024! Please Complete the Registration Form to compete at the Competition. If you have any questions, please contact DaNae Couch Lowe at DaNae@MissSouthlake.org.
Candidate Contact Information

Please include your contact information so that we can stay in contact with any questions that may arise regarding the paperwork submission.
Name*

First NameLast Name
Birthday*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Alternative Contact Information

Please designate an alternative contact. This can be a parent, sibling, or friend.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com

Miss America Proof of Registration

All Miss and Teen delegates must register with Miss America once per competition cycle. If you have not competed in a local competition yet this year, register at https://www.club.missamerica.org/miss-america-registration-texas-page.
Screenshot of Miss America Registration Confirmation*

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Rebel Athletic x Miss America

The Miss America Organization partnered with Rebel Athletic to promote women's heart health. To help, Rebel Athletic created a line of Red athletic wear that will be used for Health & Fitness. A percentage of the proceeds benefit scholarship if you use code: MAOTXGB.
To shop the Rebel Athletic x Miss America collection, please view it here.
Acknowledgement of Rebel x Miss America*

Yes, I acknowledge the above.I have a question regarding the above.

American Heart Association x Miss America
Miss America requires all Miss and Teen candidates raise $30 for the American Heart Association. Miss should set up their Spotfund here, and Teens should set up their Spotfund here. Proof of fundraising should be sent to DaNae@MissSouthlake.org by Friday, September 6.
Acknowledgement of American Heart Association x Miss America*

Yes, I acknowledge the above.I have a question regarding the above.

Eligibility Information

The Miss America Organization requires each contestant satisfy the following eligibility requirements. Please provide supporting documentation as needed.
Proof of Citizenship (Birth Certificate, Passport, or Naturalization Documentation)

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Proof of Age (Birth Certificate, Driver's License, Learner's Permit, State ID, or Passport)

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Geographic Eligibility Documentation

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Submit documentation of one of the following.

Bona Fide Residency - Legal Resident of Texas at least 30 days prior to the local Competition. Documentation should include Driver's License and one of the following: Voter ID card, lease, utility bill, vehicle registration, student loan correspondence. In lieu of driver's license, may provide two in list.

Employment Status - Employed full-time in the State of Texas at least 30 days prior to the local competition. Employer to declare status in writing or candidate may provide pay stub, W-2, tax form, etc.

Education Status - Enrolled full-time at a school in the State of Texas by the day of the local competition.
I hereby declare that the information provided is true and correct.

Clear

Paperwork Information

Need Instructions for the Resume and Fact Sheet? Email DaNae@MissSouthlake.org.
Headshot*

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Please view the 2024 Miss America Fact Sheet Instructions here.
Fact Sheet*

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Please view the 2024 Miss America Community Service Initiative Instructions here.
Community Service Initiative*

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Talent or HERStory Performance

All candidates will either use a performance talent or HERStory presentation that is 90 seconds. Please provide the relevant details below.
Performance Type*

DanceInstrumentalTwirlVocalHERStoryMonologue/Slam PoetryOther
Name of Performance Piece*
Do you require any specific production elements (Mics, cleanup of materials, etc.)? If so, please provide more information below.*
Talent Music (If Any)

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Registration Fee

Unless the Early Bird Rate applies, the Miss Southlake & Miss Westlake entry fee is $150, unless you upgrade to include a full-page ad in the program book ($200).
PayPal: DaNae@MissSouthlake.Org

Venmo: @DaNae-Couch

Check: Payable to Miss Southlake Scholarship Org and mailed to 2415 Creekside Circle N Irving, TX 75063
Have you submitted your registration Fee?*

Yes, I have paid.No, I will pay following submission of the form but prior to September 8.
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Southlake/Westlake Registration Form