2017Nyreturningpacket.Pdf
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® (For office use only) 2017 MISS NEW YORK USA ® SENT: _______________ MISS NEW YORK TEEN USA Check/Money Order Returning Contestant Application PayPal PLEASE TYPE OR PRINT NEATLY First & Last Name: _______________________________________________________________ Current Mailing Address: __________________________________________________________ City: _______________________________________ State: _________ Zip Code: __________ Home Phone: (_______) _________ - ____________ Cell #: (______) _________ - ___________ D.O.B: _____/_____/_____ Current Age: _________ Age you will be on December 31, 2016:_____ *If you are 18 yrs old on Check one: MISS NEW YORK USA *Must be at least 18, but under 27 years of age on 12/31/2016 12/31/16 - you may MISS NEW YORK TEEN USA *Must be at least 14, but under 19 years of age on 12/31/2016 compete in either age division, please check one We require all contestants to provide a valid e-mail address to receive periodic correspondence. Please list the address that you would like to get future information sent to. You may list a parent’s address if you do not have one of your own. Please print legibly. E-mail Address: ________________________________________________________________________ Emergency Contact: ___________________________________ Phone # (______) _______ - ________ Relationship to you: ___________________________________ Type of phone #: Cell Home Work Email: _______________________________________________ Copy this address on ALL future emails? Y/ N Please list occupation or name of school if student: _____________________________________________ How did you hear about us? ________________________________________________________________ If you have previously competed in this pageant, please list the last year in which you competed: __________ Preliminary Eligibility Questions Please circle one: a) Have you been and will you continue to be a permanent resident in the state of New York for the full 6 month period prior to the state pageant, from July 13th, through January 13th, 2017? YES NO b) If no to the above, are you an out-of-state resident who will complete one entire semester, trimester or summer session at a New York college or university by December 31, 2016 and will continue as full-time after that date? N/A YES NO c) If currently employed, do you work in the state in which you reside? N/A YES NO d) Do you or anyone in your immediate household or family currently (or within the last 2 years) work for (paid or volunteer) the state pageant, IMG Universe, LLC d/b/a the Miss Universe Organization, the Parties, Ernst & Young or any of its affiliates or related companies of the above? YES NO If yes, explain:____________________________________________________________________________________ e) Have you ever appeared on or applied to any TV show/contest, game, competition or reality show or a motion picture film? YES NO If yes, explain:____________________________________________________________________________________ f) Have you ever been charged with the admission of a crime, appeared in public or photographed in a state of full or partial nudity, or engaged in any illegal activity that might bring disrepute or scandal to yourself? YES NO Explain:_________________________________________________________________________________________ g) Are there any images of you on any public website or forum? (such as Facebook, Twitter, Instagram Modeling/Acting sites, etc…) If so, please list all web addresses:_________________________________________________________ YES NO h) Do you have any agency or management contract currently in effect? Expires: ____________________ YES NO *Answers to any of the above questions may not necessarily lead to disqualification; however, it is important that we are made aware so that your eligibility can be determined.* To qualify, you must be (1) A citizen of the United States (2) between the ages of 14 and 26 on 12/31/2016 and (3) never have been married, had a marriage annulled, be a parent or guardian, have given birth to a child, nor be pregnant. PLEASE RETURN THE FOLLOWING Please pay on-line with a Credit Card or PayPal or send a check or WITHIN TEN (10) DAYS: money order payable to MISS NEW YORK USA for the Registration Registration fee: $295 Fee. Please complete this Registration Application and read and sign the Preliminary Agreement and return both forms to our office Check/Money Order Enclosed at the following address: Paid On-Line Credit card or PayPal Pageant Headquarters Completed Application & MISS NEW YORK USA® Signed Preliminary Agreement P.O. BOX 137276 Please call or e-mail for extension if needed! CLERMONT, FL 34713 PRELIMINARY AGREEMENT ® ® MISS NEW YORK USA – MISS NEW YORK TEEN USA ® ® An official preliminary to the 2017 MISS USA pageant and the 2017 MISS TEEN USA pageant Independently produced by D&D Investments, Inc. Please Read Very Carefully! I hereby apply as an entrant in the 2017 MISS NEW YORK USA® or 2017 MISS NEW YORK TEEN 13. I understand and agree that all issues as to my eligibility or that of other contestants shall USA® pageant (together, the “State Pageants”) and the opportunity to compete in the national finals be determined by the State Pageants and MISS UNIVERSE ORGANIZATION, and I agree to of the MISS USA® or MISS TEEN USA® pageant, as the case may be, and I represent to and agree abide by that determination both as to myself and other applicants. Any decision to disqualify with the State Pageants as follows: any contestant or titleholder shall likewise be made by the State Pageants and MISS UNIVERSE ORGANIZATION, and I agree to abide by that determination both as to myself and REPRESENTATIONS: other applicants. 1. MISS: I will be at least eighteen (18) and under twenty-seven (27) years of age on December 31, 2016. 14. I agree to abide by all the rules of the MISS NEW YORK TEEN USA® or the MISS NEW 2. TEEN: I will be at least fourteen (14) and under nineteen (19) years of age on December 31, 2016. YORK USA® pageant and the MISS USA® or MISS TEEN USA® pageant now in effect or as 3. I am not married, have never been married, and have never had a marriage annulled. I have announced from time to time hereafter. never given birth to a child, I am not a parent or guardian of any other adult or minor person, and I 15. I understand and agree that my acceptance as a contestant for the title of MISS NEW am not now currently pregnant. These representations and warranties shall remain true through the YORK TEEN USA® or MISS NEW YORK USA® and my continued consideration for the title of State Pageant and, if I win the State Pageant, through the 2017 Miss USA Pageant. MISS NEW YORK TEEN USA® or MISS NEW YORK USA® is under the sole and complete ® ® ® discretion of the State Directors of the MISS NEW YORK TEEN USA or MISS NEW YORK 4. I have never participated in a previous national MISS USA or MISS TEEN USA pageant. ® USA pageant. 5. I have not participated and will not participate in any other state’s preliminary pageant to the 2017 MISS USA® pageant or the 2017 MISS TEEN USA® pageant, including District of Columbia. 16. I agree to permit my photograph, voice recording, and name to be used without charge for all publicity and commercial purposes and any telecasts of the state and national pageants. 6. Prior to the date of this Application and Agreement, I have not been engaged in any activities 17. I agree that, if I win or succeed to the title of MISS NEW YORK TEEN USA® or MISS NEW which, if disclosed to the public, would bring or tend to bring myself or the MISS NEW YORK TEEN ® USA® or the MISS NEW YORK USA® pageant into disrepute, ridicule, or contempt. I am in good YORK USA, the terms of this Application and Agreement, including, without limitation, health and of good moral character. Sections 17 through 22, inclusive, shall continue to be binding upon me, and that any breach thereof shall, in addition to any other right or remedy of the State Pageants (including without 7. I am a female (recognized medically and legally as female in the United States) and a citizen limitation my disqualification, loss of title and return of prizes), entitle the State Pageants to of the United States and at least one of the following is true: (a) I now reside and have resided in equitable relief and the costs and expenses of obtaining the same, including reasonable the State of New York as my permanent and primary residence for a period of at least six (6) attorneys’ fees. months immediately prior to the beginning of the 2017 MISS NEW YORK TEEN USA® or the MISS NEW YORK USA® pageant which I have entered (although I may have attended college or 18. I understand and agree that if I win or succeed to the title of MISS NEW YORK TEEN USA® or MISS NEW YORK USA®, as one of my obligations, I will go to and stay in the host city university elsewhere); or (b) I have resided in the State of New York as a full-time student at a ® ® college or university and will complete or have completed one entire semester, trimester or summer during the time required for me to appear in the MISS USA or MISS TEEN USA pageant. session by December 31, 2016 and I will continue to reside in the State as a fulltime student at that 19. I understand and agree that if I win or succeed to the title of MISS NEW YORK USA® or same school, college or university through the State Pageant and, if I win, through the 2017 Miss MISS NEW YORK TEEN USA®, all decisions concerning my preparation for the MISS USA® or USA Pageant (although I may have spent or be spending the summer in another state).