Miss World® Canada 2014 Application

PLEASE READ FAQ FOR PRE-REQUISITES TO QUALIFY *(denotes required field)

First Name: *		Last Name: *
Birth Date (mm/dd/yyyy): *		Languages:
Nationality: *		Canadian Citizen or Permanent Resident: * Canadian CitizenPermanent Resident

Emergency Contact Name: *		Emergency Phone: *

Address: *		City: *
Province: * Postal Code: *		Email: *

Telephone Day: *		Cellular Phone: *

Height: *		Weight: *
Bust Waist Hips		Dress Size Blouse Size Pant Size

Special Talents & Skills: *
Education (degrees, certification, diploma, awards): *
Tell us a bit about yourself: *
Reason for entering Miss World Canada 2014: *
Where did you hear about Miss World Canada 2014?
Did someone refer you? If so, who?

Head Shot Photo: * Evening Gown Photo: * Other Photo: *

By filling out this application, you certify that the information provided is accurate. In the event of any misrepresentation, you will automatically be disqualified to participate.

Winner Miss World Canada 2013