County & State Application Title

Thank you for your interest in the Georgia American Queen Pageant!

Please fill out the following form completely to submit your application to participate
in your state or regional pageant.

VERY IMPORTANT

Please contact Sunjia Burks for the correct application fee amount. You will have an opportunity to submit your fee via PAYPAL at the end of this form, or you may send in your fee by mail.(We will hold your data for processing until your fee arrives.)

I understand (must check to submit application)

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Please note that you must either reside, work, or attend school in the state that you are applying to represent. Also, you must enter a VALID email address in order for your application to be accepted.

Contact Information

First Name Last Name

Email Address

Address

City

State Zip Code

Phone Cell Phone

The state or regional pageant you would like to compete in:

The county you will be representing:

Choose a competition category:

Date of Birth: Month Day Year

How did you hear about the American Queen Pageant?

Referred by former contestant (Name or Title)
CosmoGirl Magazine
Pageantry Magazine
Supermodels Magazine
Internet: Which site?
Postcard
Newspaper : Which one?
Radio
Television
Referral by other than former contestant : Name?

Please press the submit button to submit your application.

After you submit your application, you must next submit your application fee. If you have trouble
with the PayPal link after your application in submitted, please go to www.paypal.com. Our "payee" address is: mrsaq2005@yahoo.com. Please note that no applications will be officially registered until your application fee has been received. If you must MAIL your application fee, please make all checks payable to Sunjia L. Burks at this mailing address:

Sunjia L. Burks
1105 Vista Terrace
Loganville, GA 30052