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PLEASE NOTE:  Deadline to enter into the 2008 Miss/Teen/Mrs. Houston Galaxy Pageants is May 15, 2008. If you have filled out an e-mail form you will receive a post card in the mail reminding you of the deadline one one prior to the first deadline. Additionally, there may be slight changes to our format, rules, regs, policies, etc.

Please make sure to complete this entire information form.

What local city/county title would you like to represent:
1st choice
2nd choice
3rd choice
(titles come on a first come, first serve basis with a $100.00 deposit)

Name:

Address:

City:               Zip Code:

Email Address:

Date of Birth:

Age:

County of Residence:

Telephone Number:

If Mrs.: Date of Marriage:

If Mrs. Or Ms.: Children

Name:                Age:

Name:                Age:

Name:                Age:

If under the age of 18, please supply the following information:

Parent's Name:     

Telephone Number:

How did you hear about us?:

I hereby apply to the:

Mrs. Houston Galaxy

Miss Houston Galaxy

Miss Teen Houston Galaxy

Payment may be made by personal check, money order, or credit card. Checks and money orders should be made payable to:

Premiere Promotions
5959 West Loop South, Suite 470
Bellaire, TX 77401

Please call the state office at 713-699-9858 if you would like to pay via credit card. Visa, MasterCard and American Express are accepted.