Appointed Representative Program Application Welcome to the Appointed Representative Program Application. If you plan to compete in the upcoming National Pageant, April 15th is the deadline to have your application submitted for the state queen’s title. We will continue to accept applications after April 15th for any remaining state or city titles still available. If you have any questions please email Candice Davis at candice@namiss.com If you are under 18 years old, please have a parent or guardian register for you.You will need to submit the following to complete this form: Answer the questions on this form Upload Resume Upload Essays Upload Photo Upload Personal Introduction Video Link Pay Non-Refundable $40.00 Registration Fee *IMPORTANT* All of these steps must be completed in order for your application to be processed. If any of the steps is not completed you will have to re-submit this form at a later date. Step 1 of 5 20% Contestant's Name:* First Last State you are applying to represent:*Choose Your State PageantAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexas (North)Texas (South)UtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAddress:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Best Phone Number For Contact:*Parent's Cell Phone:Contestant's Cell Phone:Contestant's Birth Date:* Date Format: MM slash DD slash YYYY Age as of January 1st:Choose Age456789101112131415161718192021222324How old was the contestant on Jan 1stParent or Guardian Name: First Last Additional Parent or Guardian Name: First Last Email:* Education Level Last Completed in School:*Choose LevelPre-KKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth GradeNinth GradeTenth GradeEleventh GradeTwelfth GradeCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorCollege GraduateGraduate SchoolPHDLast Grade Point Average:*Answers below may include information pertaining to the last 3 years.School/Work Activities:*Community Activities:*Awards:*What do you like to do in your spare time?:*If granted one wish what would it be?:*Life Ambitions:*Favorite Book:*Favorite Song:*Favorite TV Show:*Favorite Movie:*Favorite Cartoon Character:*Favorite Subject in School:*What is the best thing about you?:*Please list any NAM state titles that you have held. If you have never held a NAM state title, write the word "none" in the space below.* Attach Your Resume:*Attach Your Photograph:*Attach Your Essay:*Personal Introduction Video Link* Acknowledgements:By answering "I Agree" to each of the following statements and clicking the "Submit" button below you acknowledge the following:I acknowledge that all answers submitted are true and correct.*Click To AgreeI AgreeI acknowledge that I am applying for a State Queens title, to represent my state, because my state doesn’t have a physical pageant for my age division.*Click To AgreeI AgreeI acknowledge that if awarded a State Queen or City Queens title I will be financially responsible for all fees that are assigned to this title. I will make all deadlines or communicate to ARP coordinator if extension is needed.*Click To AgreeI AgreeI acknowledge that if financial responsibilities aren’t made in a timely manner or arrangements haven’t been made then I might be subject to relinquishing my title.*Click To AgreeI AgreeI understand that the National Yearbook deadline and all materials I want to be included in the National Yearbook must be in the pageant office at least three weeks prior to the first day of this year's National pageant. This includes photos, sponsor names, Spotlight Contest pages, and the payments associated with these items.*Click To AgreeI AgreeI understand that I am responsible for my own travel and lodging reservations and any expenses at the pageant. If I earned and chose the National Trip through the Spotlight Contest, then I will receive the appropriate reimbursement based on the award. (Please see the National Guidebook for more information.)*Click To AgreeI AgreeI understand that I may complete Spotlight Contest pages for the Yearbook to earn prizes such as hotel room nights (contestant must make their own reservation), sponsorship fees to the National All-American Queen’s competition, entry into the major optional contests, tickets for Disneyland®, a trip to the national pageant, the National Ambassador Title, National Cover Girl Title, the National Cover Model Title, the National Cover Miss Title, and more!*Click To AgreeI AgreeThe contestant named on this form must reside or go to school in the state she represents, and she must participate in her correct age group. Neither the contestant, nor any of her immediate family members are employed by National American Miss, Inc. or National American Miss. In consideration for being accepted as a contestant in the national pageant activities, we, the parents and/or guardians of the contestant, do hereby release National American Miss, Inc., National American Miss, its staff, directors, subsidiaries, parent companies, assignees, employees, and volunteers from any and all claims and damages directly or indirectly resulting from named contestant participating in the National American Miss events; and we give permission to National American Miss, Inc. and National American Miss to use the contestant’s photographs, speeches, Community Service entries, testimonials, videos, etc., for publicity purposes and future material in printed, video, and/or internet form. It is agreed and understood that any scholarships, prizes, or college allowances that are part of the state and national programs are provided by the named sponsor, school, business, agency, or college, and that National American Miss, Inc. and National American Miss shall have no liability in regard to such scholarships, prizes, or college allowances. It is understood that all state and national pageant fees are non-refundable without exception. Contestant must not be married, never have been married, nor ever had a child.*Click To AgreeI Agree Registration Fee* Price: $40.00 Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name
