2005 TALENT SHOW
SUNDAY, JUNE 26, 2005  -  2:00 p.m.
 Butler County Fairgrounds ~ Grand Stands

CONTESTANT ENTRY FORM
(You must be a resident of IOWA.)

Completed forms must be received by Monday, June 13, 2005**

Click to view 2005 Rules for Contestants

ONLINE ENTRY
Please complete all applicable fields
below (required fields are noted in RED)
and click the "Submit" button at the bottom.		 PRINT AND MAIL
Print this page, fill in all applicable information
and mail completed form to:
Karen Dilger
31762 235th Street
Shell Rock IA 50670-9200

For more information, call Karen Dilger at 319-885-6311 or email dilger@webiowaplus.net
 

Please Mark ONE Division:
           Sprouts Division Ages 2-12            Senior Division Ages 13-21

Name

Age (as of Sunday, June 27, 2004)    Birth Date

Type of Talent (Please be as specific as possible)

Song/Music (if applicable)

Address:

City:    State:     Zip Code:

Social Security Number

Phone:     **County:

Email:

** Area residents will receive priority until Wednesday, May 26, 2004.

If act has more than one member – list from left to right as seen from the audience:

Name: Age: Birth Date:

City: State:   Social Security Number

Name: Age:   Birth Date:

City: State:   Social Security Number

Name: Age:   Birth Date:

City: State:   Social Security Number

Name: Age: Birth Date:

City: State:   Social Security Number

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