Miss Rodeo Illinois Pageant

Miss Rodeo Illinois Pageant

Official Entry Form

____ Miss Contestant (19-25 yrs.)

____ Teen Contestant (13-18 yrs.)

Name______

Address______

City______State ______Zip Code______

Email address ______Age______Birth Date____/___/___

Telephone Number (_____) ______-______Home (_____)______-______Mobile

School ______

College ______

Special Activities:

Interests and Activities (Not horse related) ______

Awards you've received ______

______

Future Goals ______

Please list any Rodeo, Horse Show and other Horse Activities which you enjoy or participate in.

______

Please list any awards you've received relate to Rodeo, Horse Shows and other Horse Activities. ______

Please list any Rodeo, Horse Show or Horses related Queen titles you have held and the dates.

______Dates______

Name, Number and Address of Newspapers in your hometown:

Name______website ______

Address______Phone (_____) ______-______

Name______website ______

Address ______Phone (_____) ______-______

In fifty (50) words or less, explain why you would like to be Miss Teen Rodeo Illinois?

______

If you could meet one (1) rodeo or western figure from the past, who would it be and why?

______

Miss Rodeo Illinois Pageant

Photo Release, Waivers & Agreement (signatures & dates required)

Photograph Copyright Release

I certify that I am the legal copyright author for the photo(s) described herein. I authorize the *Miss Rodeo Illinois Association to make copies of the photo(s) described above for use in promotional tools as well as the Miss Rodeo Illinois website as set forth in the following:

Title of Photograph(s) ______

Description of Photograph(s) ______

Number of Copies/Sizes______

Date Permission Expires ___/___/___

Address______

______

Phone (_____) _____ - ______Date____/____/____

* As a contestant you are responsible for getting the appropriate release from any professional photographer for the photos you are submitting with your entry. Your picture(s) will not be used online or in promotional pamphlets without the photographer’s written permission. The Miss Rodeo Illinois Association is not liable if such photographs are obtained illegally from our website and reproduced in any way or manner.

Contestant Property Waiver

I certify that I am fully aware of the potential risk for lost, damaged and/or stolen property during the Miss Rodeo Illinois Pageants.* While I know the pageant personnel will do everything in their power to prevent such event from happening, I do not hold the Miss Rodeo Illinois Association, its Directors nor its committee persons responsible or liable in the event such loss occurs.

Miss Rodeo Illinois Pageants Equine Activity Waiver

State of Illinois Equine Activity Law

Under the equine activity liability act, each participant who engages in an equine activity expressly assumes the risks of engaging in and legal responsibility for injury, Loss, or damage to person or property resulting from the risk of equine activities.745 I.L.C.S. 47/

I certify that I am fully aware of the Equine Activity Law for the State of Illinois and place no liability on the *Miss Rodeo Illinois Association or its Pageants should I or my horse be injured, or should there be damage sustained to myself, my equipment or my horse.

*Miss Rodeo Illinois Association is not responsible or liable if any injury is sustained by horse or participant in route to or from any activity set forth by the Miss Rodeo Illinois Pageant.

Miss Rodeo Illinois Pageant Contestant Agreement

By my signature on this application, I hereby certify that I have read and completely understand the accompanying Official Rules and Regulations of the Miss Rodeo Illinois (MRI) pageant and I have also read and completely understand the accompanying Miss Rodeo Illinois Contract that I acknowledge these regulations to prevail throughout all the Miss Rodeo Illinois Pageant programs, activities and functions and that said regulations pertain to all persons related to my appearance at the pageant.

That I hereby grant permission to Miss Rodeo Illinois Association, also known as Miss Rodeo Illinois Pageant (hereinafter referred to as MRI Pageant) to verify any information contained on my application.

That I hereby release the MRI Pageant from responsibility of injury to persons or property, involving me or persons related to my appearance in the Miss Rodeo Illinois pageant, and which applies to the heirs, assigns, executors or administrators for me or persons relative to my MRI Pageant appearance and, that such release shall include all accredited sponsors, commercial or private, or the MRI Pageant and all officers, directors and member individuals and groups of the MRI Pageant.

I have enclosed with this application copy of my birth certificate and a copy of my health and/or medical insurance.

I hereby agree to send one (1) 8 x 10 vertical color head-and-shoulders photograph. That I hereby release title, claim and rights to photograph(s) and/or public relations materials involving me to the MRI Pageant for use in the MRI Pageant.

I certify I have never been married or pregnant or given birth to a child.

Failure on my part to disclose this information to the State officials will automatically disqualify me from my participation in any a pageant. Scholarships or prizes of any kind, which I may receive, will be returned to the pageant. State and National pageants will be released from any and all liability resulting from my actions.

In the event I receive the title of Miss Rodeo Illinois/Miss Teen Rodeo Illinois, I will complete the tenure of my title in accordance with the aforesaid regulations and in the best interest of the Miss Rodeo Illinois program; and, will relinquish all claims and perpetual items (crown, sash, prizes, etc.) all relating to the title of Miss Rodeo Illinois/Miss Teen Rodeo Illinois upon January 1 of the year my reign is complete.

I hereby affix my signature attesting my agreement to the above without reserve.

Applicant's Printed Name ______Signature______

Address______City______State_____ Zip______

Email______Phone (____)_____-______Social Security Number_____-____-_____

If contestant is a minor, under 18 years of age:

Father's Printed Name______Signature______

Address______City______State_____ Zip______

Phone: Home (______) _____-______Mobile (______) ______-______

Email address ______

Mother's Name______Occupation______

Address______City______State_____ Zip______

Phone: Home (______) _____-______Mobile (______) ______-______

Email address ______

Subscribed and sworn to me, a Notary Public, within the County of______,

State of Illinois this _____ day of ______201_____. Notary Public Seal

Notary Public______

Commission Expires______

Mail to completed form and $175.00 entry fee, postmarked by July 1, 2016 to:

Rosemary Cooper, President MRIA

18000 W State Rte 90

Princeville, IL 61559

It is suggested to send your entry with a tracking option.

6/15/16