MISS NEW YORK USA® OFFICIAL FORMS PACKET Please complete pages 1 – 14 and Mail the completed forms as well as a copy of your Birth Certificate and Proof of Residency Documents to Pageant Headquarters by the first deadline on your checklist. Before mailing these forms into Pageant Headquarters, please check to be sure you have: 1. Initialed the bottom of pages 2 – 8 2. Signed and Dated all forms where indicated Official Forms ® 2018 MISS NEW YORK USA First & Last Name: _______________________________________________________________ Your name will be printed in the Official State Program Book as written above. (No middle name or initial.) Address: ______________________________________________________________________ City: ___________________________________State: __________________ Zip: ___________ Phone Number: ( )___________________Current Age: ____________________________ Date of Birth: __________________________ Age you will be on December 31, 2017: ________ In order for you to participate in the 2018 MISS NEW YORK USA® pageant, please complete and return pages 1 - 14 of this form, plus photocopies of your birth certificate and proof of residency documents. Please refer to the enclosed checklist for your due date. Parent/Guardian signatures are required only if you are under 18 years old on the date you enter your signature. ! 1. Contestant’s Official Entry Form / Contract ! Date of birth entered on page 2 ! Shaded Boxes completed on pages 2, 3 and 6 ! Bottom of pages 2 - 8 initialed ! All signatures complete, and initials on page 8 ! 2. Release & Participation Agreement ! 3. Comportment and Hotel Responsibilities ! 4. Contestant Agreement ! 5. Pageant Weekend Rules & Regulations ! 6. Medical Information Form ! 7. Title Request Form ! 8. Proof of Age Documentation – A photocopy of birth certificate is required ! 9. Proof of Residency Documentation – (See page 15) ! One (1) document from Column A AND two (2) from Column B. The 2 items from Column B must be dated: one before 7/12/17 and one dated after 7/12/17. Please fill out all the necessary information, sign and date each form and mail them (do not fax) to: MISS NEW YORK USA P.O. BOX 137276 CLERMONT, FL 34713 1 Official Entry Form / Contract MISS NEW YORK USA® Rules, Regulations and Terms ("Agreement") For Contestants for the State Pageant Preliminary to the 2018 MISS USA® pageant I am making the representations, disclosures, and agreements described below so that I will be eligible to participate in the state pageant in the state named above (for purposes of this Agreement, the District of Columbia is considered a state) (the “State”) preliminary to the 2018 MISS USA pageant (the “State Pageant”). I understand this is an important legal document relating to my participation in the State Pageant, and by signing this document I am waiving legal rights I may have against IMG Universe, LLC d/b/a The Miss Universe Organization (“Miss Universe”), IMG Worldwide, LLC, and their respective parents, subsidiaries, affiliates and others (collectively, “the Parties”). 1. I represent and warrant as follows: occasionally travel outside my State on behalf of my employer) “Permanent (a) I understand that in this Agreement, "Miss Universe" means IMG Universe, LLC and primary residence” means my true, fixed and permanent domicile which d/b/a the Miss Universe Organization; “you" or "Licensee" means D & D I intend to make my permanent home. In order to establish my compliance Investments, Inc., who is the person or entity that conducts the State Pageant with these residency requirements, I am attaching photocopies of at least (except as otherwise defined in Paragraph 5 below); the "License Agreement" two of the following types of bona-fide documents, at least one of which means the Miss USA Preliminary State Pageant License Agreement between must be of document type (a) through (e): (a) my driver’s license; (b) my Miss Universe and Licensee; and, all other capitalized terms have the same voter identification or registration card and/or proof of voter history provided meanings as in the License Agreement unless otherwise defined in this by the state; (c) my resident tax return from the most recent tax year; (d) Agreement. lease or deed for a dwelling in my name (evidencing occupancy of dwelling for at least six months immediately prior to the commencement of the State (b) I understand and agree that you shall determine, in your sole judgment, the Pageant; (e) employment documents in my name (Form W-2 and pay stubs contestants for the State Pageant in accordance with standards prescribed by only) evidencing employment in the state for at least six months immediately Miss Universe from time to time. I understand that you have no obligation to prior to the commencement of the State Pageant; (f) my current school determine that I am entitled to serve as a contestant, even if I meet all eligibility records (e.g., transcript or report cards with my address) sufficient to requirements and any lawful selection criteria you may establish. I further establish the requirements of paragraph 1 (f) (2); (g) telephone or utility bills understand and agree that you will determine all eligibility issues for competition in my name (both the current bill and a bill dating back at least six months in the state Pageant in your sole judgment in accordance with standards immediately prior to the commencement of the State Pageant; and (h) bank prescribed by Miss Universe from time to time (although I understand that you or credit card statements in my name (both the current statement and a alone, and not Miss Universe, will be applying such standards), and I agree to statement dating back at least six months immediately prior to the abide by your determinations both as to myself and all other contestants as to commencement of the State Pageant). I will maintain such residency eligibility for competition in the State Pageant. If I am the winner of the State through the State Pageant and, if I win the State Pageant, through the 2018 Pageant, I understand and agree that Miss Universe will, in its sole judgment, Miss USA Pageant. If I am living at home and attending school and am determine who will serve as a contestant in the 2018 Miss USA Pageant and unable to provide one of the other forms of identification, I will furnish current determine all eligibility issues for competition in the 2018 Miss USA Pageant, bona-fide school records to validate my residence sufficient to establish the and I agree to abide by Miss Universe determinations both as to myself and requirements of paragraphs 1 (f) (2). I understand and agree that you have other 2018 Miss USA Pageant contestants. I further understand that if I am the the right to reject information or documentation you feel has not been winner of the State Pageant, Miss Universe’s only obligation will be to accept gathered or provided in good faith. me as a contestant in the 2018 Miss USA Pageant, provided that I at all times (2) I have resided in the State as a full time student at a school, college or have satisfied all the eligibility requirements and complied with and fulfilled all of university and will have completed one entire semester, trimester or summer my obligations, including, without limitation, those obligations set forth in this session immediately prior to December 31, 2017 and I will continue to reside Agreement (including, without limitation, Paragraphs 1 {h} and 5 below) and in in the State as a fulltime student at that same school, college or university the Contestant Official Entry Form/Contract for the 2018 Miss USA Pageant. I (although I may have spent or be spending the summer in another State). further agree to accept the obligations I will incur as a contestant for the State In order to establish my compliance with these residency requirements, I am Pageant under this Agreement. attaching bona-fide copies of my current school records (e.g., transcript or (c) I have never been married or had a marriage annulled. I have never given birth report cards). I understand and agree that you have the right to reject to a child, I am not a parent or guardian of any other adult or minor person, and I information or documentation you feel has not been gathered or provided in am not currently pregnant. These representations and warranties shall remain good faith. I will maintain such residency through the State Pageant and, if I true through the State Pageant and, if I win the State Pageant, through the 2018 win the State Pageant, through the 2018 MISS USA Pageant. Miss USA Pageant. Is the foregoing statement, either (f1) or (f2), TRUE_____ FALSE_____ " (d) I am a citizen of the United States and will remain a citizen of the United States If the above is not true, & you answered FALSE, you must explain below: through the State Pageant and, if I win the State Pageant, through the 2018 __________________________________________________________ MISS USA Pageant. __________________________________________________________ __________________________________________________________ (e) I represent and warrant that I am a female (recognized medically and legally as a __________________________________________________________ female in the United States). If my gender or sex designated at birth was not female, I represent and warrant that: (a) I have fully completed sex I understand that, unless you (in accordance with standards prescribed reassignment (which can be certified by a physician, if requested by Miss from time to time by Miss Universe) decide in your sole judgment to accept Universe or the State Pageant Director); and (b) I have received and can other documents that you consider satisfactory, you will not accept any provide (if requested by Miss Universe or the State Pageant Director) legal documents other than the documents referred to above in order to recognition of my assigned sex as female by the U.S.