Mid-South Pride Pageant/Ambassador Registration Form

Full Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Date of Birth*

Date

Select Your Division*

MrMissMx

Address (Please be prepared to show your drivers license, this must be the address you live at)

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Stage Name

Years Performing

Do you live within 75 miles of Memphis, TN? (Please be prepared to show your drivers license)*

YesNo

Will you attend the monthly community meetings?

YesNo

Why would you like to represent Mid-South Pride and be an ambassador to our community?*

Upload Promo Picture

Pageant Rules*

I have read the pageant rules

Title Holder Agreement*

I have read the title holder agreement

Images and Video Release*

I give Mid-South Pride Foundation permission to use images or video of myself for their promotions.

Privacy Policy*

I have read the privacy policy

Please verify that you are human*

How would you like to pay?*

Pay by cardHave an invoice sent to you to pay

My Products

Registration FeeFee for participating in the Mid-South Pride Pageant/Ambassadors.

$50.00

Total

$0.00