Name

Email Address

Street Address

City

State

Zip

Phone Number

Age

Employer

School & Class

Sex Sex Male Female

2019 Participant 2019 Participant Yes No

Group GroupIndividual (Describe act below)Group Act (In space below, describe act, list participants & what they do)

Describe Your Act

*Rules Agreement: *Rules Agreement: do you agree to the Talent Contest General Rules

Number