Participant Application The BasicsParticipant Name* First Last Email* Phone*Street Address*Address Line 2City*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code*Birth Date* Date Format: MM slash DD slash YYYY Age*Program*Rising Stars (Ages 5-9)State Participant (Ages 10-35)Shooting Stars (Ages 35+)Select a program below based on the participant's age as of January 1st of the year of the qualifying national event.Parent 1* First Last Parent 2 First Last Head Shot Photo*Accepted file types: jpg, jpeg.This photo will be included in the event program book. Please attach a head shot with clear resolution. File format should be JPG or JPEG and maximum file size is 5 MB.Proof of Disability*Accepted file types: pdf, jpg, png, jpeg, html.Any girl or woman who meets the definition of disability under the government laws and acts defining a disability (Disability Discrimination Act 1995: “A person has a disability for the purposes of this Act if he has a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities.”) is eligible to participate in a Miss Amazing Pageant. We ask all applicants to submit one of the following documents as proof of qualification: Front page of IEP, 504 plan, SSI, or physician's documentation of disability.Passion Presentation DetailsProvide a short description of your presentation*(Important: the time limit for talent is typically 2 minutes, but varies by state.)What is the title of the piece?*(Important: the time limit for talent is typically 2 minutes, but varies by state.)MiscT-Shirt Size*Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-LargeAdult XXX-LargeHow did you hear about us?*Search EngineFriend or Family MemberSocial NetworkNewsStoryOtherN/ACommunication Preferences*EmailMailing AddressEmail and Mailing AddressNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.