Midwest Rose of Tralee
Preliminary Rose Entry Form - This entry is free!
Name: ______________________________________________________________
Address: ______________________________________________________________
City: _________________State: ____________Zip: _______________
Phone: _____________________________Cell:____________________________
Email: ______________________________________________________________
Date of Birth: _____________________________________
(Must be 18-27 years old – by August 20, 2010)
Father’s Name: _________________________________________________________
Mother’s Name: _________________________________________________________
Sisters and Brothers:
Name: __________________ Age: ______ Name: _________________ Age: _______
Name: __________________ Age: ______ Name: _________________ Age: _______
Name: __________________ Age: ______ Name: _________________ Age: _______
School Name: (If applicable) ____________________________________________
Irish surnames in your family: _____________________________________________________________
_____________________________________________________________
Signature of applicant:
_____________________________________________
Date: ________________________________________________________________
Preliminary application due: February 22, 2010.
For more information visit our website at www.chicagoroseoftralee.com
If chosen as a Midwest finalist, sponsorship entry fee is $300.00.
Return completed form with a photo.
Mary Kay Marmo
11137 S. Artesian
Chicago, Illinois 60655
773-239-3927
