Official Application Miss National CSA Contest - CSA Fraternal Life

Name: Home Phone: Cell Phone: Email: Current Address: I am a member of Lodge. No. Date of Birth: Place of Birth: Hair Color: Eye Color: Height: Explain, in detail, your activities as a member of CSA: Give a short explanation of your goals in life: If you're currently employed, tell us where you work: What do you do there?
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Official Application Miss National CSA Contest Name:

Home Phone:

Cell Phone:

Email:

Current Address: I am a member of Lodge

No.

Date of Birth:

Place of Birth:

Hair Color:

Eye Color:

Height:

Explain, in detail, your activities as a member of CSA:

Give a short explanation of your goals in life:

If you’re currently employed, tell us where you work:

What do you do there?

If you’re currently a student, tell us what school you attend:

Where is it located? What is your major? What is your intended occupation?

2050 Finley Road Suite 70, P.O. Box 249, Lombard, IL 60148 · 800-LIFE-CSA MCSAPRGMAPP_REV04062016

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Miss National CSA Contest Application Tell us about your family. Father’s Name:

CSA Member? □Yes

□No

Mother’s Maiden Name:

CSA Member? □Yes

□No

Family Address: Family Contact Name and Phone Number: Siblings: Name:

Age:

Occupation/School:

Name:

Age:

Occupation/School:

Name:

Age:

Occupation/School:

Name:

Age:

Occupation/School:

Tell us about any family history or information you’d like to share:

2050 Finley Road Suite 70, P.O. Box 249, Lombard, IL 60148 · 800-LIFE-CSA MCSAPRGMAPP_REV04062016

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Miss National CSA Contest Application Tell us about your education, activities, and interests. High School: College or University:

List your degrees or any honors you’ve received and the school that awarded them:

What activities have you participated in at school?

Tell us any other interesting information about your school years:

List any clubs or organizations you belong to now and any offices held:

What are your hobbies?

What musical instrument do you play, if any?

2050 Finley Road Suite 70, P.O. Box 249, Lombard, IL 60148 · 800-LIFE-CSA MCSAPRGMAPP_REV04062016

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Miss National CSA Contest Application Other than the information written in the preceding parts of this application, give us a brief autobiography. Do not exceed 250 words.

2050 Finley Road Suite 70, P.O. Box 249, Lombard, IL 60148 · 800-LIFE-CSA MCSAPRGMAPP_REV04062016

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Miss National CSA Contest Application

Release I hereby authorize the Fraternal Department of CSA to use the information contained in this Entry Application, and the picture submitted with it, for the purposes of publicity in the CSA Journal and other newspapers or media.

Signature of Contestant

Permanent Address

City, State, Zip

Attention Contestants: Please check this application very carefully to make certain that all information has been properly submitted. Sign and return it to CSA’s Fraternal Department.

Thank you and good luck!

2050 Finley Road Suite 70, P.O. Box 249, Lombard, IL 60148 · 800-LIFE-CSA MCSAPRGMAPP_REV04062016

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