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									                                                                        2011 AMERICAN GIRL FASHION SHOW ®
                                                              PRESENTED BY THE JUNIOR LEAGUE OF CENTRAL WESTCHESTER


                                                                                                            (Please print)



                Here’s your chance to stroll down the runway at the American Girl Fashion Show!
  Ten lucky girls, age 5 and over, will be featured at each of our shows during intermission. She’ll model an exclusive
                                                                      ®
 American Girl Fashion Show t-shirt, and carry her own American Girl doll while our announcer tells the audience a little
about her (based on the questions below). The American Girl Guest Model experience is $25 and includes the souvenir t-
                                                           shirt.
                          Please note that a children’s ticket to the fashion show is also required.


CHILD’S NAME:

PARENT/GUARDIAN’S NAME:

ADDRESS:

CITY:                                                                       STATE:            ZIP:

HOME PHONE:                               CELL PHONE:                                EMAIL:

SCHOOL:                                                                                       GRADE:

BIRTHDATE: month:                                 day:             year:            AGE AS OF MARCH 19, 2011:

T-SHIRT SIZE:          □ SMALL          □MEDIUM           □LARGE           □EXTRA-LARGE

                                               Which show are you attending?
                                       Saturday, March 19 at 9:30am
                                       Saturday, March 19 at 1:30pm
                                       Sunday, March 20 at 11:00am
                                       Sunday, March 20 at 3:00pm

          Please tell us a little about our Guest Model by answering at least 3 of the following questions!

What does our Guest Model want to do when she grows up?




What is her favorite birthday treat?
What does she like best about school?




What does she like to do when she is not at school?




Does she have a favorite pet (please include the pet’s name, species, breed, etc.)




What is her favorite book/movie/song and why?




What makes her shine?




By registering for this event:
  I give the Junior League of Central Westchester and its employees, volunteers, sponsors, agents,
    successors, licensees and assignees permission, in connection with any photographs taken during said
    event of yourself and/or any of your dependents or in which you or they are included with others, the right
    to use and reuse, in any manner at all, photographs in whole or in part, either by themselves or in
    conjunction with other photographs, in any medium and for any purposes whatsoever, including without
    limitation, all advertising, promotional or publicity uses, and release the Junior League of Central
    Westchester and its employees, volunteers, sponsors, agents, successors, licensees and assignees from
    any and all claims, actions, demands and liabilities arising out of or in conjunction with the use of said
    photographs.
  I agree to have my child participate in all mandatory requirements, including fittings, photographs, and
    orientation.
  I hereby release and hold harmless the Junior League of Central Westchester and their employees,
    volunteers, sponsors, agents, successors, licensees and assignees from any and all claims, actions,
    demands and liabilities arising out of or in conjunction with or my or my dependent's participation in the
    meetings, orientation, fashion show and/or any aspect of the events described herein.

Parent/Guardian Signature:                                                     Date:
  Enclosed is a check in the amount of $25 made out to Junior League of Central Westchester.

Remember, your application is not complete without a payment of the $25 guest model fee.

Applications must be postmarked by March 1, 2011. Any applications received after that date will be
considered on a first come, first served basis.


                                For Junior League of Central Westchester Office Use Only




                                                Junior League of Central Westchester
                                 Wayside Cottage 1039 Post Road Scarsdale, New York 10583-3036
             JLCentralWestchester.org E-Mail: jlcwamericangirlFS@verizon.net Phone: (914) 723-6130 Fax: (914) 723-6016
                                                                         2011 AMERICAN GIRL FASHION SHOW ®
                                                             PRESENTED BY THE JUNIOR LEAGUE OF CENTRAL WESTCHESTER
                                                                                                M ARCH 19 & 20, 2011
                                                      LAKE ISLE COUNTRY CLUB, 660 POST ROAD, EASTCHESTER, NEW YORK


                                                                 Souvenir Program Spirit Ad

            Celebrate your child’s special day
  with an ad especially for her in our souvenir program!
                                                $25 per Spirit Ad

Your message:
(Maximum 3 lines and 30 characters per line including punctuation and spaces)




Model’s Name:

Your Name:

E-Mail Address:

Daytime Number:


  □ Payment included in check (made payable to JLCW) and mailed with registration (check #       )
                                                 OR
 □ Credit card - please complete credit card authorization form and mail or fax BOTH forms to (914)
                                              723-6016.


 Be sure to copy this form for friends, grandparents and other
                        family members!
                             DEADLINE FOR SPIRIT ADS IS MARCH 1, 2011

                                              Junior League of Central Westchester
                               Wayside Cottage 1039 Post Road Scarsdale, New York 10583-3036
           JLCentralWestchester.org E-Mail: jlcwamericangirlFS@verizon.net Phone: (914) 723-6130 Fax: (914) 723-6016
                                                                2011 AMERICAN GIRL FASHION SHOW ®
                                                  Guest Model Application Credit Card Authorization


I,                                                                    hereby authorize the JUNIOR LEAGUE OF
CENTRAL WESTCHESTER, Inc. (“JLCW”) to charge my credit card for the American Girl Fashion Show Model fee and /or
noted amount below for the Spirit Ad(s).

Name of Model:

                   x $25 Guest Model Fee             =
                   x $25 Spirit Ad                   =
                          Total                      =

                                               □DISCOVER □ VISA □ MasterCard

Credit Card Number:

Expiration Date:                    /                    SEC Code:



Amount to be charged               $                 .

Credit Card Billing Address:

Name as it appears on the card:

Street:

City:                                                                     State:                    Zip Code:

Telephone: (         )                                          Cell: (       )

Email:


Cardholder's Signature

Date:
                                                  Junior League of Central Westchester
                                   Wayside Cottage 1039 Post Road Scarsdale, New York 10583-3036
               JLCentralWestchester.org E-Mail: jlcwamericangirlFS@verizon.net Phone: (914) 723-6130 Fax: (914) 723-6016

								
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