Name *

Please list as you want announced.

First Name

Last Name

Introduction *

Please indicate if you will introduce yourself or need us to introduce you.

I will introduce myself.

I prefer for WCFA to introduce me.

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Release of Liability *

I hereby waive Woodford County Fair, any associates and/or volunteers from any liability of injury, loss, or damage to person or property associated with the Shining Stars Pageant and the Woodford County Fair.

I agree

I do not agree

Photograph Release

I give permission for any and all pictures to be published for any purpose and in any form (such as, but not limited to, social media, website, advertising)

Yes, I give permission.

No, I do not give permission.

Do you plan to use a wheelchair during this event? *

Yes I will use a wheelchair.

No I will not use a wheelchair.