Pageant Registration

Step 1 of 4 - Contact Information

Contact Information

Legal Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Phone Type*

Alternative Phone:

Phone Type

Contestant Information

Stage Name*

Years Performing*

Promo Photos

Include at least one headshot and other images we can use for promotional purposes. Photos can also be uploaded later at midsouthpride.org/upload

Drop files here or

Accepted file types: jpg, heic, png, Max. file size: 614 MB, Max. files: 10.

Instagram*

Facebook*

Bio*

Interests:*

Community Involvement:*

Do you live within 50 miles of Memphis?*

Yes

Are you committed to improving our community?*

Yes

Will you commit to attend required meetings and events?*

Yes

Agreements

Consent to Release*

By signing, I hereby release and hold harmless Mid-South Pride, their agents, servants, or members from any liability associated with or arising from my participation in this pageant, including but not limited to personal injury, loss of or damage to personal property, whether before, during, or after the pageant.

I release myself from rights and any proceeds from the sales of any video, still photography, or taping of this pageant. I also agree that my name and any photography of me during this pageant may be used for publication for promotional or advertising purposes. By my signing below I affirm and attest that I have read and agree to abide with the Rules and Regulations of this pageant.

I agree to the release

Pageant Rules*

By checking I confirm that I have read and agree to abide by the Pageant Rules.

Privacy Consent*

I agree with the Privacy Policy

Checkout

Pageant Entry Fee*

Price:

Total

Payment Options

Pay Now

Pay Later

Credit Card

Payments are securely processed via Stripe.

Card Details

Cardholder Name

Entries are considered Pending until payment is submitted in full.

Phone

This field is for validation purposes and should be left unchanged.

Contact Information

Contestant Information

Agreements

Checkout

About This Form

Pageant Details