Mid-South Pride Pageant/Ambassador Registration Form

Mid-South Pride Pageant/Ambassador Registration Form

Register to participate in either the Mr, Miss, or Mx divisions. All are welcome as long as you live within 100 miles of Memphis, TN.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
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 Code
Stage Name
Years Performing
Do you live within 100 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

Cancelof
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

My Products*

Pageant Registration FeeFee for participating in the pageant

$50.00

Total

$0.00