Banner Sponsors Dirty Bird Bikini Dream Catcher Strobe Magazine Darque Tan Rebel Girl Clothing 304 Marketing

Online Application

Contestant Information
Name: Birthday:
    Age:
Address: Apt#:
City: State:
Zip: County:
Day Phone: E-mail:
Alternate Phone: Web site:
Occupation:    
School:    
Contestant Characeristics
Height: Weight: .lbs
Hair Color: Eye Color:
Measurements: B: W: H:
Piercings:    
Tattoos:    
A Little Information About Yourself
Personality:      

Accident Waiver and Release of Liability

I certify that I am physically fit to participate in this event and have not been advised otherwise by a qualified medical person.

I acknowledge that this Accident Waiver & Release of Liability form will be used by the event holders, organizers, and sponsors, in which I may participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and my assigns as follows: (A) Waive, Release, and Discharge from liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my travleing to and from the event, 304MARKETING, LLC, their directors, officers, employees, volunteers, representatives, agents, event holders, event directors, event volunteers, (B) Indemnify and Hold Harmless the entitles or persons mentioned in this paragraph from any and all liabilities or claims as a result of participation in this event, whether caused by negligence of release or otherwise.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during this event. And further consideration of permission being granted to participate in the Miss WV Bikini-USA contest and their related events (the Event), receipt of which benefit is hereby acknowledged, I hereby grant you, 304MARKETING, or Director, and all video entertainment organizations, and all their agents, successors, licensees, and assigns the right to photograph or otherwise reproduce (whether by film, tape, still photography or otherwise) my voice, appearance, name, to exhibit, distribute, transmit, and/or exploit any such reproductions containing my voice, and/or appearance in all media, including without limitation, by means of still photography, motion pictures, video, printing or any other media known or hereafter devised, including also with respect to merchandising, advertising, and/or publicity, and the right to use my name and information about me in any connection with the foregoing.

This Accident Waiver & Release and Liability shall be construed broadly to provide a release and waiver to the maximum extent possible under the applicable law. The rights granted to me hereunder are granted for the entire universe and shall endure perpetuity, and no further compensation shall be deemed to obligate you, 304MARKETING, Director, and any and all approved video entertainment organizations hereunder this Accident Waiver & Release of Liability be construed broadly to provide a release and waiver to the maximum permissible under the applicable law.

I also understand that tax any money compensation or any prizes I may receive are my sole responsibility, and not that of 304MARKETING, or any of their directors, agents, or employees.

I understand that photo, video, and/or live video or radio broadcasts or other imagery may be in production during the contest. I further understand that the Director has no control or influence, either express or implied, regarding images produced by the general public, media, judges, or any other entity that my be in attendance during the contest. The images taken by the Director, 304MARKETING, or their assigned agents or employees, are the sole property of the Director and may be used by the Director at their discretion for publicity purposes in the media, website or printed literature. I understand that I will not be further compensated for the use of my name, appearance and/or picture or video reproduction.

  I agree and Understand I disagree  
       
The Application must be accompanied by a $25.00 registration fee. When you click submit, you will be directed to the PayPal site where you can pay this fee. Click the submit button to send your application and pay the $25.00 registration fee.

Checklist: Please review the following, and bring to contest:

  1. Completed Entry Form
  2. Completed Accident Waiver & Release of Liability
  3. $25.00 Entry Fee (payable by sponsor)
  4. Photocopy of ID
  5. 2 current photographs to be judged for competition