Thank you for your interest in becoming a 2017 YMBP Contestant!  

Participation will be limited to 20 contestants.  ALL questions MUST be answered to be considered for an applicant interview.  Contestants will be notified if accepted into the program.  

In addition to this application, please email a photocopy of most recent Report Card to by Saturday, February 11, 2017.

It can also be mailed to:
YMBP, Inc.
795 E. Delavan Avenue,
Buffalo, New York 14215.

Please press 'Click to Begin' to start filling out your application.
Click to Begin
Personal Information

Name *

Age: *

Address *

City/Town *

State *

Zip Code *

Home Phone Number *

Applicant's Cell Phone: *

Family Information

Mother/Guardian's Name *

Mother/Guardian's Phone Number *

Father/Guardian's Name *

Father/Guardian's Phone Number *

School Information

Elementary School Name *

Elementary School Graduation Year *

Elementary School Honors and Activities *

High School Name *

High School Graduation Year *

High School Honors and Activities *

Other Information

Any other accomplishments and honors *

Career Ambition and Why? *

Hobbies and Interests *

Favorite Color & Why? *

Favorite Food *

Favorite Music Artist/Group *

Favorite Movie *

Socia Media Information

SnapChat *

Twitter *

Instagram *

Facebook *

Employment/Volunteer Information

Employment/Internship Experience *

Community Service Affiliation and Activities *

Medical and Dietary Information

Please list any dietary restrictions (i.e. religious, allergies, vegetarian): *

Please list any special medical, physical or educational needs, medical conditions, or allergies the board and committee should be aware of: *

Pageant/Talent Information

What issue would you like to focus on if you are selected as Young Miss Buffalo 2017? This should be something you are passionate about? *

What type of talent will you perform in the pageant? *

Do you have any performing arts training? *

If so, What? *

6. Please list all information that medical providers, staff and chaperones may need to know for the proper care of your child in case of an emergency:

Asthma - Inhaler: *

Allergies - List: *

Seizures Explain: *

Diabetes Insulin Type: *

Heart Murmur: *

Other Conditions (Be specific): *

Medications Being Taken: *

As we receive applications, we will be scheduling applicant interviews in February. Please share which interview date is most convenient for you? *

How did you hear about us? *

Fill in your name and your Parent/Guardian's name as a proof of both signatures.

Applicant's Signature (please type your name below): *

Parent/Guardian's Signature (please type your name below): *

Thank you for submitting your application.  All applicants who answer all questions and submit the required attachments will be contacted for an applicant interview.

Please feel free to use the icons below to share this application with other young ladies who may be interested in our program.

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