Register ONLINE!
We are excited that you have decided to join us for the third annual Queens for a Cure pageant!
Please help us prepare to make this a wonderful event for you and your family by completing the registration
form below.  Please fill out one form per contestant. If you have already sent in your entry form and fees, you do not
need to complete the form below.
 

Contestants Name

CONTESTANT REGISTRATION

Contestants Name:   Contestant Age:

Date of Birth:

Address:

City: State: Zip:

Contestant Email: Contestant Phone:

Parents Name:

Referred By:

Age Division:

I plan to raise a minimum $100 additional donation for the Race for the Cure

Eye Color: Hair Color:

Favorite TV Show / Movie:

Favorite Book:

Ambition:

Queens for a Cure Registration
Includes Mandatory Events and One Chaperone Badge
 		 $50.00
Optionals
Best Dress Best Model Prettiest Hair
Prettiest Eyes Best Smile Best Introduction
 		 $5.00 ea
$25.00 all
Rose Pre-Order
Single Rose $5  Three Roses $10
A limited quantity of roses will also be available at the pageant for family and friends to purchase for their favorite contestant. If you want to be guaranteed that roses will be available for your contestant, we recommend you order in advance.
 		 $5.00/1
$10.00/3
Cover Model
All contestants names will be printed in the program book. If you would like your contestants photo printed in the book, the fee is $10. Photos must be received by October 29th and must be emailed to queensforacure@comcast.net. BONUS - all photo submissions will be judged by a separate panel of judges and the highest scoring photo will be printed on the back cover of the program book! The winner will also receive a banner and crown from Queens for a Cure and the title of COVER MODEL!
 		 $10.00

 

$5.00 xtra

 
Perfectly Pink Model
It's all about pink! Submit any photo that features the color PINK to be considered for this contest!  Photos must be received by October 29th and must be emailed to queensforacure@comcast.net. BONUS - all photo submissions will be judged by a separate panel of judges and the highest scoring photo will be printed on the back cover of the program book! The winner will also receive a banner and crown from Queens for a Cure and the title of PERFECTLY PINK!
 		 $10.00

 

$5.00 xtra

 
     
Admission
Children $3ea (3-12 yrs)  Adults $5ea		 $
  $TOTAL

 

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Click HERE to register a Survivor

 

Queens For A Cure
November 5, 2011
 Everett Historic Theater
2911 Colby Ave
Everett, WA 98201


Hostesses: Kennedy Miller & Victoria Knight
 Directors: Heidi Krajewski, Nicole Miller,
Virgie Flascher and Carol Roberts
Royalty Coordinator: Taylor Wall

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