NORTH CAROLINA CONFERENCE OF TEMPLES AND COURTS

Ancient Egyptian Arabic Order Nobles Mystic Shrine

Of North and South America and Its Jurisdictions, Inc.

Youth Talent Competition Entry form

(Please Print or Type)

Temple / Court Sponsoring___________________________________________________________

Contestant Full Name________________________________________________________________

Permanent Address_________________________________________________________________

Telephone No.______________________________________________________________________

Cell Phone No. _____________________________________________________________________

Date of Birth________________________________________________________________________

Parents / Guardian(s) Name __________________________________________________________

School Name___________________________________________________Grade_______________

School Address_____________________________________________________________________

Type of Talent Performing:

Mail completed for to: Dt. Damie Warren, #78

4219 Maureen Drive

Charlotte, NC 28205

704-531-6649

DEADLINE FOR ENTRY: MAY 15, 2010

If bringing a CD or tape to Gala Day please bring the original. Some copies will not play on the equipment that is being used at the competition.