MIDDLE GEORGIA IDOL 

                                                             NOVEMBER 3, 2016

                                                         REGISTRATION FORM

Mail to Family Counseling Center 277 MLK Blvd. Suite 203 Macon, Ga. 31201 by 5:00 PM on 10/31/16.

Name __________________________________ ____ Age _____ Date of Birth __________

Address ________________________________________________________________________

Email address ____________________________________ Telephone # ______________

School or Occupation ______________________________________________________________

Age Category: ( ) Age 11 – 14 ( ) Age 15 – 17 ( ) Age 18-25

Give a brief description of your performance: __________________________________________

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DISCLAIMER STATEMENTS

Middle Georgia Idol is not affiliated with the FOX Network’s or its affiliate’s “American Idol”. The Middle Georgia Idol is a fundraiser event to benefit Family Counseling Center of Central Georgia. A $10.00 non-refundable, tax deductible registration fee is required to participate. No Auditions required. Participants must submit to Family Counseling Center the lyrics to the song he/she will be performing by October 31, 2016. Lyrics can be faxed to (478) 745-0881, emailed to kgfcc@aol.com or dropped off at Family Counseling Center at the address below. Failure to submit the lyrics will disqualify the participant. Payment of the registration fee does not guarantee a spot to perform during the November 3RD, 2016 Middle Georgia Idol, if the guidelines are not followed. By signing this registration form, you agree to all terms, conditions and rules of the event. Official RULES will be provided upon receipt of your completed registration form and fee.

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Signature – Participant age 18 and older Date

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Signature – Parent/Guardian of Participant Age 17 and under.

To pay on line go to the donation section of this web site or mail check or money order payable to Family Counseling Center and mail to 277 M. L. King Jr. Blvd., Suite 203, Macon, Georgia 31201.

OFFICIAL USE ONLY

Date Received _______________________ REGISTRATION # __________

Registration Paid $__________ ( ) Cash ( ) Check # ________ ( ) MO # ____________