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.
For more information, please contact:  info@chicagoroseoftralee.com


Mary Kay Marmo
11137 S. Artesian
Chicago, Illinois 60655
773-239-3927