Surname, Given name: Date of birth: Place of birth: Contact number: Address: Suburb: State and Postcode: Email: Hobbies and Talents : Would you be interested in entering a national Miss Polonia contest? Yes No
Date of birth:
Place of birth:
Contact number:
Address: Suburb: State and Postcode: Email: Hobbies and Talents : Would you be interested in entering a national Miss Polonia contest? Yes No
Suburb:
State and Postcode:
Email:
Hobbies and Talents :
Would you be interested in entering a national Miss Polonia contest? Yes No
