*If you can not copy this form just let me know and I will be happy to send you one.

Name:____________ Age:_____ B.D.________ Address:_____________City:______

State:______ Zip:_______Phone:_____Email:_______________

Check (X)

$5 1-2 Photos____ $7 3-5 Photos____ $10 unlimited up to 6-8 Photos ____ $1ea. add ____ Any Discount ____

Total #of pics ___Total of fees ____

*If you are a mini winner would you prefer (Free Entry)_____ or (Mailed Gift)____

Send PP to supremediva@bellsouth.net

*SEND PAYMENT AS MONEY OWED!

Send Photos/Entry to pcelitefashion@yahoo.com

If you have a discount,
please state it above.

*SIGNATURE REQUIRED*
I am the parent or legal guardian
of the contestant or
I am of 18 years of age.
I have read and understand all
the rules regarding PC'S ELITE.
By signing below,
I agree to all terms.
See "rules" for more details. Parent/Guardian:__________Date:______

If you can not copy this form just let me know and I will be happy to send you a form.

Email me anytime with questions.

Thanks, Ms. Keysha....
:: All information
submitted is confidential. ::