58th Camellia Queen Pageant 2015 Sponsored by: The Biloxi Lions Club Contestant Application (Type or Print Clearly) _________________________________________________________ Last Name: _____________________________First:___________________ Middle: _____________ Address: _______________________________ City: ___________________ Zip Code: ___________ Contestant Birthdate: _____________ Age: ______ Contestant Phone #:____________________ Parent’s Names: _______________________________ Parents Phone #: _____________________ Honors held in community and school: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Hobbies/Interests:___________________________________________________________________ School Presently Attending ______________________________ Grade: _____________________ What are your plans after High School? _______________________________________________ _____________________________________________________________________________________ Sponsor: __________________________________ Contact Person: _________________________ Address: _______________________ City: ___________ Phone #: ___________________________ DATE OF PAGEANT April 4, 2015 Beau Rivage – Camellia Ballroom Get Acquainted Party March 29, 2015 BEFORE RETURNING APPLICATION Enclose one black & white or Color photo (head & shoulders) suitable for newspaper and program. Enclose check/money order for $75.00 entry fee, payable to “Biloxi Lions Club” DEADLINE FOR APPLICATION IS MARCH 12, 2015 Please return to: Mrs. Jaye Brice, 1070 Judge Sekul Avenue, Biloxi, MS 39530 For further information or questions call 228-374-8175 NOTE: If you are interested in selling ads or have your own ad for our program, please visit the Club website at www.biloxilionsclub.org and click Camellia Queen Program ad form.