Miss Teen Kerala North America

Full Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address (OPEN TO US & CANADA ONLY)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Name *

First Name

Last Name

Phone *

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Name (First Contact) *

First Name

Last Name

Phone *

(###)

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Name (Second Contact)

First Name

Last Name

Phone

(###)

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Have you participated in a pageant before? *

Yes

No

Miss Teen Kerala North America - Pageant Agreement *

CLICK HERE TO READ THE PAGEANT AGREEMENT

By submitting this form, I confirm that I am the parent or legal guardian of the Miss Teen applicant and agree to adhere to all rules and guidelines set forth in the Contestant/Titleholder Agreement.

Consent *

By submitting this form, I consent to being contacted via email and/or phone regarding the registration process.