NAME________________________________________________________________________

ADDRESS_____________________________________________________________________

PHONE_______________________________________________________________________

BIRTH DATE___________________________________________________________________

SCHOOL ATTENDING__________________________________________________________

COLLEGE ATTENDING_________________________________________________________

OCCUPATION, IF NOT STUDENT________________________________________________

I hereby acknowledge I have read the official rules and that I am complying with them in every way and that the personal data herein set forth is correct in every way.

_____________________________
CONTESTANT'S SIGNATURE

PARENTS/GUARDIANS NAME___________________________________________________

PARENTS/GUARDIANS ADDRESS________________________________________________

PARENTS/GUARDIANS SIGNATURE______________________________________________