Would you like to become Miss Universe® Canada 2011? Fill out the following information and we will get back to you directly. To qualify for the 2011 competition, you must be a Canadian Citizen and at least 18 years of age and under 27 years of age by February 1st, 2011. (All fields are required)

If you meet the basic requirements, we'll be sending you an application form to participate in a Casting or Local pageant to select the finalists for the Miss Universe® Canada pageant.

 
Name:
Address:
City:
Province:
Postal Code:
Phone Number:
Email:
Birth Date (DD/MM/YYYY)

  


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