Mid-South Pride Pageant/Ambassador Registration Form

Mid-South Pride Pageant/Ambassador Registration Form

Register to participate in either the Mr, Miss, or Mx divisions. All are welcome as long as you live within 100 miles of Memphis, TN.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Select Your Division
Address (Please be prepared to show your drivers license, this must be the address you live at)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Stage Name
Years Performing
Do you live within 75 miles of Memphis, TN? (Please be prepared to show your drivers license)
Will you attend the monthly community meetings?
Why would you like to represent Mid-South Pride and be an ambassador to our community?
Upload Promo Picture

Cancelof
Pageant Rules
Title Holder Agreement
Images and Video Release
Privacy Policy
Please verify that you are human
How would you like to pay?

Registration Fee

Fee for participating in the Mid-South Pride Pageant/Ambassadors.

$50.00

Total