IJM Florida and Texas Application IJM Florida and Texas Application Contestant's Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Contestant's Birthdate Date Format: MM slash DD slash YYYY Age Division (as of Jan 1, 2022)Princess (ages 4-6)Jr. Pre-Teen (ages 7-9)Pre-Teen (age 10-12)Jr. Teen (age 13-15)Teen (16-18)Miss (19-24)Parent's Name (If under 18)Parent's Phone NumberContestant's Phone Number* I acknowledge that the person filing out this digital form is the contestant (age 18 or older) or the Parent/Guardian.** I acknowledge that I have of my own will, applied to represent a state/region/country for International Junior Miss Pageants in the appropriate age division as determined by my age as of January 1, 2022.** I acknowledge that all fees paid are non-refundable.** I acknowledge that in accepting a state/region/national title, I understand that I must get written permission from the International Office before participating in any pageants and will only participate if permission is granted.* I acknowledge that the entrant must compete in the correct age division and must not be married or never have been married or have had a marriage annulled. I acknowledge that age divisions are determined by attained age as of January 1, 2022.** I acknowledge that International Junior Miss may change the date and/or location of the State/International Finals if deemed necessary due to government orders or disaster.** I acknowledge that I agree to forever hold International Junior Miss, its directors, employees, volunteers, affiliated entities, sponsors, and staff members harmless of any and all claims and damages or liabilities due to theft, accident, loss, illness, or injury during or resulting from my child/my participation in the 2022 International Junior Miss International Finals or any International Junior Miss Preliminary/State/Regional Programs or activity or event.** I acknowledge that I give permission to International Junior Miss to forever use my/the entrant's photographs, speeches, testimonials, videos, etc. for publicity purposes and future material without compensation.** I acknowledge that International Junior Miss is not responsible for any sponsored prizes or awards that are not fulfilled by sponsors.*