Name *
Date of Birth *
Date of Birth
Address *
I am an Australian citizen or permanent resident *
At least 18 years of age when the Australian competition commences, and under 28 years of age by January 1, 2019 *
I will have a valid passport (valid until at least January 1st 2021) *
I am not married / nor have I ever been married *
I am not pregnant and I have never given birth *
I understand the organisers reserve the right to disqualify me at any time, at their own discretion, including if I get married/pregnant during the competition, or do something to bring the competition into disrepute *
I am available for all Miss Universe Australia events and media opportunities throughout 2019, including for potential travel to National and International Finals and personal development trips as part of the preliminary program *
If no, please specify dates that you are unavailable
I have committed a crime, or been involved with inappropriate behaviour including photographs and or films, which may cause embarrassment to both parties if disclosed *
If yes, please specify
I am currently represented by a modelling agency *
If yes, please specify
Australian size
I am happy to receive communication from Pink Tank Events and official sponsors *
I understand that during event time, the rehearsals, fittings for shows and any other preparation for the parades, heats, and final are priority *
I consent to my personal information including my name, email contact and any photo or video image of me being shared with any sponsors of Miss Universe Australia as Pink Tank Events deems necessary, but that my phone contacts will be kept private unless I personally authorise it to be shared with specific sponsors/media *
I understand and agree that I will be photographed and filmed on all official activities and that this footage can be used by Pink Tank Events and its supporting media groups, on an ongoing basis, to promote Miss West Coast/Miss Universe Australia, or to be used on any form of media (print, digital or social) at any stage in the future. To the extent necessary, I transfer and release any rights I have over any images or footage taken of me to Pink Tank Events to be used as they see fit to promote the Miss Universe competition or its sponsors or organisers *
I give the Miss Universe Australia event promoters approval to use my image/s for promotional purposes throughout the event and for future event promotions and I release and indemnify Pink Tank Events from any liability whatsoever in relation to the use of such images *
I also understand that by ticking YES below I am committing to participating in the competition and program this year and will give it my all, and can potentially win a place as a national finalist. I have read and understand all sections of this form *
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