Application for Local Contestants

Contestant Name *

First Name Last Name

Age Division *

Local Competition *

Miss Northern Suburbs - open to all residents of Illinois; Miss Lake County - only open to residents of Lake, McHenry, Kane, Dupage and Cook counties.

Contestant E-mail *

Contestant Phone Number *

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Birth Date *

/ Month / Day Year

Talent *

Platform *

Please list the service projects you are involved with. *

Estimate of the amount of hours you have volunteered for your service projects. *

Please estimate the amount of funds raised through these service projects. *

Have you volunteered with Children's Miracle Network Hospitals? *

Yes No

If yes, how many hours?

What is the dollar amount you have raised for CMNH? *

Have you competed in the Miss America Organization previously? *

Yes No

If yes, what level and what year?

Do you have any relatives who have served as a volunteer, judge, or other official with the Miss America Organization? *

Yes No

If yes, please list the relation, position and last volunteer date.

If you've answered yes, your eligibility must be reviewed by a state official prior to being officially accepted as a participant in the Miss America Organization.

AFTER completing the local application and contract, please set up your Children's Miracle Network Hospitals fundraising page as soon as possible. Go to www.missamerica4kids.org and follow the prompts to make your page. You are required to raise $100 for Children's Miracle Network Hospitals. Deadline to raise funds is one week before the Local Competition is to take place. If you do not raise the minimum $100, you will be disqualified from the Local Competition.

*There are no fundraising requirements for teens to compete at a local, but it is encouraged.