Name
*
Email Address
*
Address
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City
*
State
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Zip
*
Home Phone
Work Phone
Mobile Phone
Name of Song and Artist
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Have you, ever performed the above talent as a professional? (Meaning the principle source of your income is performing)
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Yes
No
By Initializing the box below -- I acknowledge that I have read the entry rules and agree to abide by them.
Parent Name (if under 18)
Initials of Contestant or Parent/Legal Guardian if under 18
*