MARION COUNTY FAIR / WJBD RADIO TALENT CONTEST 2010

OFFICIAL ENTRY FORM

To participate in the Marion County Fair Talent Contest, you must fill out this form, sign and mail to the address at the bottom of this page. If this is a group entry, all other members of the group MUST list their names, addresses, ages and birthdays on the reverse side. All members of the group should be familiar with the rules and information of the contest. Please fill out this form completely and sign before mailing to: Marion County Fair Talent Competition: P.O. Box 21 Salem, Il. 62881  ENTRIES MUST BE RECEIVED BY June 15, 2010.  YOU MUST USE THIS FORM TO ENTER NO OTHER FORM WILL BE ACCEPTED.

Name of Contestant (or group leader):   ______________________________

Street Address:   ________________________________________________

City, State, Zip: Phone Number:   ___________________________________

Age of Contestant:   ______________________________________________

Date of birth of contestant   ________________________________________

Division  __ Junior Division (age14 and under as of July 31, 2010)                                                                       

              __ Senior Division (age15 to 21 as of July 31, 2010) 

Type of Act: ____________________________________

Number of persons in act: _____  Equipment needed __________
Title of selection:   _______________________

Accompaniment used (circle):   piano,   cassette tape,   band,   cd            

/ have read and understand all the contest rules. I also agree to abide by the rules and guidelines established by the Marion County Fair Talent Competition Committee and to conduct myself in a courteous and sportsmanlike manner.

Signature of contestant (or group leader)    ________________________       Date:  __________