To fill out this form click the Print me! link in top left corner of this page
Print form, complete & fax or copy, complete & email to missunitytv@gmail.com
Miss Unity Australia Pty. Ltd. Phone:+61 0407 894 471 Fax:+612 9713 7774
PO Box 322
Five Dock NSW 2046
APPLICATION FORM FOR MISS UNITY IN AMERICA - LAS VEGAS 2012
Entrants need to obtain sponsors to participate - Sponsorship 1
Please return form to your Event Director who will issue you with tickets once the Sponsorship has been paid please attach a copy of your paypal receipt. Deadline for Registration is 11th June 2012.
REGISTRATION FORM FOR ___ Miss Unity-Miss Unity Fashion Show in America - Las Vegas 2012
Name:___________________________________Age:_____Occupation:________________________
Phone:Work:____________________Home:____________________Mobile:_____________________
Address:____________________________________________________________________________
Email:______________________________
Height:_______ Weight:________ Bust:_______ Waist:_______ Hip:_______ Shoe:_______
Please email a photo of yourself to your Event Director.
How did you hear of us?_____________________________________
Divisions (tick)
___Teen Teens 13-17yrs
___Miss - Adults 18-30yrs
___Ms - " Open Age
___Mrs. " Open Age
___Miss - Adults 18-30yrs
___Ms - " Open Age
___Mrs. " Open Age
___Miss Sports Model " Open Age
This section is for Sport at the USA Event entry is via Sponsorship 1
For those participants who are competing for Mr. Unity tick this section:
___Sports Model " "
You will need to wear 4 outfits Swimwear, Casual, Theme & Evening.
Sponsorship 2012
Participants need to be sponsored for Sponsorship 1
Participants need to be sponsored for Sponsorship 1 Sponsorship 1: ____ $600.00 includes 6 tickets. (America - Las Vegas) July 21, 2012.
Sponsorship 2: ____ $1000.00 for a 5 Star American Business Award purchase of 4 tickets.
Sponsorship 3: ____ $1000.00 for a 5 Star International Business Award to purchase 4 tickets for the Inernational Event.
the Inernational Event. Sponsorship 4: ____ $250 for an advertisement for the Event Program - America.
Sponsorhip 5: ____ $250.00 for an advertisement for the Event Program - International.
Sponsorship 6: ____ $100.00 for 4 copies of the Event Program - America.
Sponsorship 7: ____ $100.00 for 4 copies of the Event Program - International
Total: $______________
PAYMENT BY: ____PAYPAL (admin@missunity.com)
You can use your paypal account to pay in US dollars, email name, admin@missunity.com just make sure on the notes that you include the name of the entrant, age and location.
Please fax to +61 97137774 or scan & email to missunitytv@gmail.com
Declaration:____(Tick if you agree) I the participant declare that I am drug free & agree to consent for value received and without further consideration or compensation to the use (full or in part) of all videotapes/images taken of me and/or recordings made of my voice and/or written extraction in whole or in part, or such recordings or musical performance for the purposes of illustration, broadcast or distribution in any manner. I also agree to release all claims or damages for injuries or other mishaps and am responsible for my own health & behaviour at all times & release us from all liability, before, during or after the competition in all aspects of the event/s and that the information I have supplied is truthful, this is a condition of registration.
If under 18yrs I am the parent/guardian who gives permission:
Print Name________________________Signed_______________________ Dated:____________________
For Registration payment use your paypal account for a secure payment.
