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KERALA CENTER
Year 2001 Youth Festival
Registration Form


1. Name ( Last, First, MI )_______________________________________________________________

2. Date of Birth _______________________________ 3. Citizen Y/N

4. Grade in School/ College_____________________________________________

5. Parent's name & Address_____________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

6. Phone_______________________________
7. Best time to call __________________________________





Youth Festival Part 1


Name Items entering

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

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Youth Festival Part 2


Name Items entering

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________




Year 2001 Beauty Pageant ( Kerala )


Name_______________________________________________________________________

Fees enclosed, cash/check ( payable to Kerala Center 2001 Celebrations)
$_______________________________________________________________


I have read and understood the rules and regulations and shall abide by them.

Signature__________________________________
Date: __________________

Counter signed by parent__________________________________
Name ________________________________ Date: __________________