Personal Information Given name : * Family name : * Date of birth : * Address : * Town : * Province : * Postal Code : * E-mail : * Telephone : * Cell phone or other : Emergency telephone : * Height : * Weight : * Occupation : * Known allergies : Known medical problems : Other pertinent information :

Picutres * Please include 2 pictures (jpeg) for your profile data sheet.

Motivation* Have you ever participated in this contest ? If yes, when ? * Have you ever been involved in a gala or parade ? If yes, where, when and what ? * Why do you wish to participate? (Brief explanation) *

*** A photographer will be available throughout the evening to take pictures of the candidates. These pictures can be used at a later date for publicity purposes.

I fully consent to participate in this contest and I respect and accept the rules that were communicated through this form and the application guide.

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