Junior Talent Show Registration Form (21 Under) - $250 Cash Prize to winner
Centennial Plaza Saturday, March 14th, 10 am - 2 pm * There will be Local Celebrity Judges but also a donation voting system for two ways to win a trophy. All monies raised will go to our 1st Responders Grant Program. Mississippi Heroes is a 501c3.
List group members if doing a group act. As the group leader, you are signing on behalf of all participants.
Name of Participant or Group Leader (list all members below)
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Description of your act
Have you demonstrated your talent somewhere before?
Yes
No
If yes, please explain here
Do you need special equipment to make your show happen?
Yes
No
If you need it, write down the equipment & if you are bringing it.
Have you performed before?
Yes
No
If yes, please give the name where
Why do you want to participate in this talent show
Please write down info we can use as an introduction on the mic
What's the most interesting thing you can tell about yourself or your group?
Headshot or Group Photo
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Video (optional)
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I hereby consent to the storing, processing and transferring all or part of all or part of the visual and audio output I have given while filling this Application Form for use in programs on all channels belonging to related TV channel and group companies.
Signature
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