ENTRY FORM Copy and paste and print or email completed to us

2008 WV AUTUMN ENTRY FORM

EARLYBIRD SEPT.13, FINAL in hand by SEPT 30

Name: __________________________________________________________________________

Name for Stage: ______________________ Birthdate: _____/_______/___________ Age _____

Street Address: __________________________________________________________________

Mailing Address: __________________________________________________________________

City: ________________________ State:____________________ Zip: _____________________

Home: (____)_____-_______ Cell:(____)____-_______Work: (____)____-________________

School/College:____________________________________________________________________

Major: ______________________________________ Minor: ______________________________

Honors and Awards(NO pageant titles): _______________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Hobbies and Past Times: ___________________________________________________________

_________________________________________________________________________________

__________________________________________________________________________________

School/Community Activities: _______________________________________________________

__________________________________________________________________________________

___________________________________________________________________________________

FAVORITES

Foods: ____________________________________________ Color: ________________________

TV Shows: ______________________________________________________________________

Movies: _________________________________________________________________________

Actor: ________________________________ Actress: __________________________________

Book(s): ________________________________________________________________________

Author(s): _______________________________________________________________________

Song(s): ________________________________________________________________________

Singer(s) or Group(s): _____________________________________________________________

Vacation Spot: ___________________________________________________________________

Moment: ________________________________________________________________________

Person(s): _______________________________________________________________________

Skills and Training (Art, Music, Dance,Sports,etc)

List All and why you like it: _________________________________________________________

___________________________________________________________________________________

____________________________________________________________________________________

Within One Year I'd Like: ___________________________________________________________

__________________________________________________________________________________________

Within Three Years I'd like: _________________________________________________________

___________________________________________________________________________________________

Within Five Years I'd like: __________________________________________________________

___________________________________________________________________________________________

Before I die I would like to: _________________________________________________________

___________________________________________________________________________________________

Use extra paper if you need to and you may also retype this form as shown, print it out and mail it to us as we need a legitimate fresh signature. All CONTESTANTS under 18 MUST also have a parent sign.

Contestants Signature: _________________________________________________ Date: _____

Parents Signature: _____________________________________________________ Date: _____

CHECKS must be payable to Sue Loyd and mailed with completed form, fee and wallet photo to Sue Loyd, c/o WV Autumn Festival, 13 Depot Street, , Flatwoods, WV 26621