Full Name* Street Address* City* State* Zip* County Home Phone Work Phone Cell Phone Email* Place of Employment Age* Weight Height What show do you want to participate in?* Bluefield, WV - Jan. 6-7, 2012 Charleston, WV - Jan. 13-14, 2012 Summersville, WV - Jan. 20-21, 2012 Williamson, WV - Feb. 3-4, 2012 Welch, WV - Mar. 2-3, 2012 Millwood, WV - Mar. 9-10, 2012 Have you had any previous modeling or been in any bikini contests? Yes No If yes, please list... How did you hear about the contest? Radio TV Newspaper Poster Internet Word of Mouth Bikini Photo 1* Just point to a file to upload from your computer by clicking Browse Bikini Photo 2*