Please fill out the entire application.  Thank You!
Click on your age division in the drop down menu next to the pink arrow.  Age divisions are attained by the contestant's age as of January 1, 2018
Today's Date:  00 / 00 / 0000
                    First Name
           Middle Name
               Last Name
                       Street Address
     Zip Code
     Home Phone Number
   Cell Phone Number
             Email Address
      Facebook Name - URL
         Parent or Guardian First & Last Name(s)
    Date of Birth
      Age Today

                         Name of School, City and State Included
            Grade Level
             Miss Jr. America Scholarship Pageant, LLC., 2018
             Black Diamond Entertainment 2018
            All Rights Reserved

Please list below next to the pink arrow: your hobbies, what activities your are involved in and what you enjoy doing in your spare time:

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A $95.00 Registration Fee and a $200.00 Deposit must be submitted with your application.                                                       
Registration, Deposit and Sponsorship Fees are NON-REFUNDABLE
I acknowledge that ALL Fees are NON Refundable .
$295.00 Registration Fee and Deposit are Included
Please Select Which Credit Card You would like to use
Credit Card Number
Expiration Date
3 Digit Number on Back
Name on Card
Address for this Credit Card 
Phone Number Associated with this Credit Card
Area Code
Phone Number
If you were referred by a friend, whom may we thank?
Official State Appointed Application 
Please Check this box "I AGREE"
Please type in your Name for Authorization
Today's Date
Please Click Your Payment Option Next to the Pink Arrow
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