Registration Form

MISS BHARAT NEW YORK 2019

SPECIAL GUEST - SHAMITA SHETTY - BOLLYWOOD STAR

Fill The Application

Please Select Your State , Pageant Name & Category *

Upload Your Picture

First Name *

Last Name *

Referred By

Address 1 *

Address 2

City *

Zip *

State *

Phone *

Age *

Height *

Zodiac Sign *

Gender *

Birth Date * +

Birth Place

Whats App *

Website

Languages spoken *

Do you need an interpreter

Education

Your occupation:

Father’s name:

Mother’s name:

Guardian’s name (if different from parents’):

Email *

Guardian’s address:

Optional (NA)

Hobbies and Interests:

Why do you want to participate in this pageant?

Pls Provide Talent Information...

Special Requirements:

 Microphone  Microphone and Podium  Other (please describe)

HEALTH INformation  Vegetarian  Non-Vegetarian

List any food that you are allergic to:

Any special dietary needs

Please list any and all handicaps that apply to you:

List any and all medicines that you are currently taking:

Name of health insurance: Policy #

Your physician’s name: Tel:

References:

Any information that was not included in the application may be stated here:

Coupen Code

Entry Fee *

These Entry Fee Includes:-

Ramp Walk Training

Grooming , Lunch and Dinner

Conference call session , Phone Support

Please Read And Sign.. Any information that w Me Or I have read carefully and agree to follow the Rules and Regulations for the Above pageant I wish to enter. I certify that the information presented in this form is correct and true. I understand that the Mydream Entertainment reserves all rights pertaining to this contest and its decision is final. All Entry Fee Non Refundable All THE REGISTRATION FEE NON REFUNDABLEas not included in the application may be stated here: WRITE YOUR NAME IN BOX *

All the payments are final and NON REFUNDABLE - SIGN HERE *

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Checklist:  Proof of Age  Proof of residency For Mydream Entertainment use only: