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2. Full Name*
3. Name you go by*
5. Age*

   In order to be eligible to compete, you must be at least 17 years of age and be no more that 24 years of age on April 30 of the year of competition.

6. Date of Birth (mm/dd/year)*
7. Cell:*
9. Permanent Address*
   Contestant may be away attending school but parents address (permanent address) must be in Bluffdale to be eligible.
10. City*
12. Contestant's Email (please check often)*
14. Parent's Names*
16. High School*
17. Year Graduated
19. College
20. Degree and Date
22. Are you currently attending school?*
23. Name of School
25. Education Goals*
27. List 4 talents/hobbies you have*
    Talents do no have to be performing talents
29. Special training in music, drama, dance, sports, etc.*
31. A 10-hour platform project is required and will go toward your participation points (15%) of your final score at the pageant
    List 1 or 2 potential platforms & projects you are interested in presenting
33. 1.*
35. 2.
37. Why are you interested in participating in the Miss Bluffdale Scholarship Program?*
39. Emergency Contact Name*
40. Cell*
42. Relationship*
44. Emergency Contact Name*
45. Cell*
47. Relationship*
49. Are you able to attend all of the workshops listed (see list). *

    Attendance of the workshops will go toward participation points (15%) of your final score at the pageant. Please list any conflicts from the workshop schedule.

51. Are you able to attend all the City Events and Parades (see list)?*

    If there is an event you absolutely cannot attend, you can send a substitute in your place from the pageant contestant pool from 2022 All dates and times are subject to change. A more final list will be provided.

53. I understand that I need to find a sponsor for AT LEAST $250 and have the check written to Bluffdale City. The money will be used to support the Miss Bluffdale program. The check needs to be brought to the February 10th workshop. I understand that this sponsorship money is non-refundable. Sponsors' support goes toward the pageant, not the contestant. A sponsor letter will be provided at the orientation meeting.

55. Electronic Signature*

    By checking 'I Agree', you agree to acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.

    1. I Agree
57. Contestant Signature*
59. Contestant Signature*
    I hereby acknowledge that the personal information listed above is correct.
60. Date*

62. **All contestants will need to sign a contract by orientation regarding scholarship money and the Miss Bluffdale requirements. If under 18, a parent signature will also be required on the contract. Contact the Pageant Director, Nicci Christianson at 801-809-3243 or nicci.kevern@gmail.com with any questions.

64. After you click submit, you will be redirected to a page to pay the $50 registration fee. Your application is not complete until you pay the registration fee.

66. For office use only
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68. $50 NON-REFUNDABLE Application fee included with application ____________
69. Date application received ______________
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71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field