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PHOTO CONTEST APPLICATION FORM

You may apply by mail.
Send a copy of this form, Your photo (see rules), and
$25 Entry fee to:
BARONE MODEL AGENCY
5597 SEMINARY ROAD SUITE A-12-SOUTH
FALLS CHURCH, VIRGINIA 22041

Photos will be returned, if you include a self
addressed, STAMPED envelope.

PLEASE SEND YOUR $25 ENTRY FEE WITH A COPY OF THIS FORM.( There are no additional fees or hidden charges)

NAME ____________________________________

ADDRESS___________________________________

CITY_______________________________________

STATE____________________ ZIP_________________

TELEPHONE:
HOME_________________________________

WORK________________________________

SIGNATURE___________________________________

PARENT OR GUARDIAN (If under 18 years old)
_____________________________________