CQ Contest Registration: *Asterisks are required fields.
CONTESTANT INFORMATION:
*Full Name:
*Age (6-17 only):
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KID
*Age (18 & Up):
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ADULT
PERFORMANCE CATEGORIES:
01. Individual Dance:
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No Entry
1 Dance Entry @ $20.00
02. Individual Vocals:
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No Entry
1 Vocal Entry @ $20.00
03. Individual Actor:
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No Entry
1 Actor Entry @ $20.00
04. Individual Music:
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No Entry
1 Music Entry @ $20.00
05. Individual Open:
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No Entry
1 Open Entry @ $20.00
06. Group Dance:
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No Entry
2 Group Dance Entry @ $40
3 Group Dance Entry @ $60
4 Group Dance Entry @ $80
5 Group Dance Entry @ $100
6 Group Dance Entry @ $120
7 Group Dance Entry @ $140
8 Group Dance Entry @ $160
07. Group Vocals:
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No Entry
2 Group Vocals Entry @ $40
3 Group Vocals Entry @ $60
4 Group Vocals Entry @ $80
5 Group Vocals Entry @ $100
6 Group Vocals Entry @ $120
7 Group Vocals Entry @ $140
8 Group Vocals Entry @ $160
08. Group Actor:
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No Entry
2 Group Actor Entry @ $40
3 Group Actor Entry @ $60
4 Group Actor Entry @ $80
5 Group Actor Entry @ $100
6 Group Actor Entry @ $120
7 Group Actor Entry @ $140
8 Group Actor Entry @ $160
09. Group Music:
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No Entry
2 Group Music Entry @ $40
3 Group Music Entry @ $60
4 Group Music Entry @ $80
5 Group Music Entry @ $100
6 Group Music Entry @ $120
7 Group Music Entry @ $140
8 Group Music Entry @ $160
10. Group Open:
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No Entry
2 Group Open Entry @ $40
3 Group Open Entry @ $60
4 Group Open Entry @ $80
5 Group Open Entry @ $100
6 Group Open Entry @ $120
7 Group Open Entry @ $140
8 Group Open Entry @ $160
ADDITIONAL WAYS TO SHOW YOUR SUPPORT:
11. Auditions DVD:
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No Entry
1 Auditions DVD @ $20
2 Auditions DVD @ $40
3 Auditions DVD @ $60
4 Auditions DVD @ $80
5 Auditions DVD @ $100
6 Auditions DVD @ $120
7 Auditions DVD @ $140
8 Auditions DVD @ $160
12. CQ Events DVD:
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No Entry
1 Contest Events DVD @ $35
2 Contest Events DVD @ $70
3 Contest Events DVD @ $105
4 Contest Events DVD @ $140
5 Contest Events DVD @ $175
6 Contest Events DVD @ $210
7 Contest Events DVD @ $245
8 Contest Events DVD @ $280
13. Donation & Sponsorship Levels:
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CQ Sponsorship Levels
Title ........ $20,000
Legend .... $15,000
Platinum .. $10,000
Gold ........ $ 7,500
Silver ....... $ 5,000
Bronze ..... $ 2,500
Benefactor $ 1,000
Supporter.. $ 500
Associate... $ 250
Friend ....... $ 100
14. 16 Things "CQ" T-Shirts:
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No Entry
01 Tee-Shirt @ $20
02 Tee-Shirts @ $40
03 Tee-Shirts @ $60
04 Tee-Shirts @ $80
05 Tee-Shirts @ $100
06 Tee-Shirts @ $120
07 Tee-Shirts @ $140
08 Tee-Shirts @ $160
09 Tee-Shirts @ $180
10 Tee-Shirts @ $200
11 Tee-Shirts @ $220
12 Tee-Shirts @ $240
13 Tee-Shirts @ $260
14 Tee-Shirts @ $280
15 Tee-Shirts @ $300
16 Tee-Shirts @ $320
17 Tee-Shirts @ $340
18 Tee-Shirts @ $360
19 Tee-Shirts @ $380
20 Tee-Shirts @ $400
21 Tee-Shirts @ $420
22 Tee-Shirts @ $440
23 Tee-Shirts @ $460
24 Tee-Shirts @ $480
25 Tee-Shirts @ $500
26 Tee-Shirts @ $520
27 Tee-Shirts @ $540
28 Tee-Shirts @ $560
29 Tee-Shirts @ $580
30 Tee-Shirts @ $600
31 Tee-Shirts @ $620
32 Tee-Shirts @ $640
33 Tee-Shirts @ $660
34 Tee-Shirts @ $680
35 Tee-Shirts @ $700
36 Tee-Shirts @ $720
37 Tee-Shirts @ $740
38 Tee-Shirts @ $760
39 Tee-Shirts @ $780
40 Tee-Shirts @ $800
41 Tee-Shirts @ $820
42 Tee-Shirts @ $840
43 Tee-Shirts @ $860
44 Tee-Shirts @ $880
45 Tee-Shirts @ $900
46 Tee-Shirts @ $920
47 Tee-Shirts @ $940
48 Tee-Shirts @ $960
49 Tee-Shirts @ $980
50 Tee-Shirts @ $1000
FOLLOW-UP GALA DINNER FUNDRAISER & SILENT AUCTION: Free Entry For Contest Winners Placing 1st, 2nd & 3rd! Date & Location: TBD (2nd Week in June)
15. Gala Performance Dinner & Silent Auction:
MAKE SELECTION
No Entry
01 CQ Gala Dinner Ticket @ $120
02 CQ Gala Dinner Tickets @ $240
03 CQ Gala Dinner Tickets @ $360
04 CQ Gala Dinner Tickets @ $480
05 CQ Gala Dinner Tickets @ $600
06 CQ Gala Dinner Tickets @ $720
07 CQ Gala Dinner Tickets @ $840
08 CQ Gala Dinner Tickets @ $960
09 CQ Gala Dinner Tickets @ $1080
10 CQ Gala Dinner Tickets @ $1200
16. Silent Auction Item(s) Contribution:
17. Other:
PARENTAL CONTACT INFORMATION:
*Parent/Guardian Full Name:
*Address:
Apt/Suite:
*City:
*State/Zip: Zip:
*Telephone #: Ext:
* E-Mail:
Company:
Occupation/Title:
ADDITIONAL INTEREST(S):
16Things Newsletter:
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Subscribe
Unsubscribe
BCL Workshops:
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Start
Attend
Subjects of Interest:
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Education
Health & Hygiene
Health & Nutrition
Life Skills
All Of The Above
Volunteering:
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Yes, with BCL Workshops
Yes, with Fundraising Events
Yes, with Grant Applications
Yes, with Organizational Tie-Ins
Yes, with Public Relations
Yes, with getting Sponsors
Yes, with Any of the Above!
Sorry, No Can Do Now
Donating:
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Cash Donation for 16 Things
Facility for BCL Workshops
Facility for Fundraising Events
Services for Fundraising Events
Silent Auction Items
Are there Organizations in your area that might be willing to work with "16 Things Kids Can Do?" on behalf of Children and Parents? Please List:
Organization 1:
Organization 2:
Organization 3:
HELP US, HELP YOU. A SHORT SURVEY:
Gender?
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Male
Female
Marital Status?
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Doesn't Apply, I'm a Kid
Single
Married
Civil Union
Widowed
Divoriced
Number of Children?
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0
1
2
3
4
5
6
7
8
9 or More
Children's Ages?
Adult Ages in Household?
How many families do you know that would be benefit from this program?
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01-09
10-20
21-35
51-75
76-100
151 - Up
101-150
COMMENTS:
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