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TIOGA COUNTY FAIR QUEEN CONTEST
APPLICATION FORM

Name____________________________________________________

Address__________________________________________________

City_____________________________________________________

State_____  Zip Code______________________

Phone__________________________________

Birthday: 
Month _____   Day _____  Year _____  Age_____

Parent's Names____________________________________________

 If Queen becomes pregnant at any time during her reign, she will immediately relinquish her title.

Contestant's Signature_______________________________________

Parent's Signature __________________________________________

PLEASE ENCLOSE RECENT PHOTO AND YOUR
WRITTEN ESSAY OF 300 WORDS OR LESS

Mail application to:
     Jennifer Thomas Gluszczak
     1018 E. Hill Road
     Covington, PA   16917