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Miss South Coast 2015 Entry Form:
Name* __________________________________ Surname*_______________________________________
ID Number*_______________________________ Age* _______ Date of Birth*________________________
Physical Address*___________________________________________________________________________
City*_____________________________________ Province*_______________________________________
Postal Address_________________________________________________ Code________________________
Personal Contact Details
Cellphone*________________________________ Email*__________________________________________
Twitter Address*___________________________ Facebook Profile _________________________________
Parents/Guardians Contact Details
Name____________________________________ Surname _______________________________________
Telephone Home___________________________ Facsimile _______________________________________
Cellphone_________________________________ Email __________________________________________
Entrants Measurements
Bust*_______ Waist*______ Hips*_______ Height*_____ Weight*_____ Shoe Size*_____Dress Size*______
Languages Spoken*_________________________ Occupation*_____________________________________
Matriculation year*_________________________ Tertiary Qualifications _____________________________
Medical Aid Name___________________________ Medical Aid Number ______________________________
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Principal Member (medical Aid)_______________________________________________________________
Why do you want to enter Miss South Coast?
_________________________________________________________________________________________
Previous Competitions Won?_________________________________________________________________
Details of current modeling contracts/commitments ______________________________________________
Modeling Agency, if any: _____________________ Telephone Numbers ______________________________
How did you find out about entering Miss South Coast (please tick):
TV
Other, please specify
FaceBook
Magazine
Newspapers
Rules of the Competition
Applicants must :
a) be at least 18 years old and under 25 on the 1st July 2015;
b) be a South African Citizen and in possession of a valid South African ID document or passport;
c) be currently in matric / in possession of a matric certificate or equivalent qualifications;
d) not be married or had a marriage annulled;
e) not be engaged;
f) never been pregnant, never have given birth and not be currently pregnant;
g) not have any visible tattoos;
h) have no criminal record;
i) Endeavor to get a valid driver’s license as a motor vehicle is the main prize of the competition and to obey
by the rules of the main sponsor (FORD) on how to maintain their vehicle for the year of usage;
j) False information will lead to disqualification.
The judges’ decision is final and no further correspondence will be entered into. The Miss South Coast Queen
will be required to perform at a limited number of engagements.
PLEASE ATTACHED THE FOLLOWING WITH YOUR ENTRY FORM
1. A Certified Copy of your birth certificate, ID Document or Passport.
2. Two recent A4 color photographs (One head and shoulders, one full length) dressed appropriately.
Proudly brought to you by the Lions Club of Port Shepstone (www.sheppielions.co.za)
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NB: Only one entry per contestant may be submitted. Entries close:_27th June 2015
Entry fee : R100. Those selected for the finals will have to pay an additional R400.
27th June : 12 Finalists will be selected. 5th – 11th July : Finalists return for the week building up to the final
crowning ceremony at the South Coast Lions Show on 11th July.
Bank Deposit details :
Port Shepstone Lions Club
First National Bank Port Shepstone
Account No. 62034356461
Branch : 220-228
Reference : Your Name Please
Your Entry Form and all required documents, including your
bank deposit slip can be either faxed to 086 517 0505 /
emailed to [email protected] or delivered
to : Ideal Homes (next to Umtentweni Spar) or C.P. Moldt’s
Jewellers, Shelly Centre, Shelly Beach.
Closing date for entries : 20th June 2015.
For any further enquiries, please contact either Myrna Masson on 083 419 2073 or Anita Hulley on 083 632
5681 or visit our website http://lionsshow.sheppielions.co.za
Disclaimer :
I hereby consent and grant permission to the organizers and their sponsors to make any audio and/or visual
recording of my performance, interviews or other event that might take place in respect of my entrance into
the Miss South Coast Pageant and grant them an indefinite right to broadcast any such performance,
interview and/or event at any time. I confirm that I have read and accepted the terms and conditions
applicable to the contest which appear on the Lions Show website (http://lionsshow.sheppielions.co.za).
I also hereby confirm that I am medically and physically fit to participate in the Pageant. The Port Shepstone
Lions Club, sponsors and organisers will not be liable for any damages, loss of property or injuries arising from
any cause whatsoever.
I have read through the above disclaimer and am in full agreement thereof. I also hereby confirm that all the
information entered above is true.
Signature
Date
Proudly brought to you by the Lions Club of Port Shepstone (www.sheppielions.co.za)