FIRST: LAST:
Address: City:
State: Zip:
County:
(Area): Phone:
(Area): Evening Phone:
(Area): Fax:
E-MAIL:
Height:
Weight:
Age:
Hair Color:
Date of birth:
Occupation:
Marriage Date:
Husband's Name:
Occupation:
Children:
Step-Children:
GrandChildren:
Career and/or Educational Accomplishments: Other Accomplishments:
Community Involvement and Volunteer Work:
Favority Charity:
Why:
Met your husband:
Hobbies:
Three words that describe you:
Favorite Saying:
Favorite Family Tradition:
What is the greatest challenge facing married couples today?
If you are selected for this title, what platform or issue will you speak
on throughout the year?
I will agree to the rules and regulations stated within this
agreement. By signing and mailing, e-mailing or faxing this application,
I hereby state that all information contained in this application is
true. Any misrepresentation of the truth wil cause immediate
disqualification from competition. Any fees paid are non-refundable after
deadline dates.
Found out about the pagent:
Deadline date:
Signature: _______________________________
SSN#: _________________________
Today's Date:
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