Crown Order Form MISS USA Crown MISS Teen USA Crown "*" indicates required fields Crown Usage Agreement1. I am choosing to purchase an optional crown for use prior to the State Pageant. 2. Usage of my crown will be completed at the completion of the State Pageant. 3. I understand if I use this crown for public appearances that are NOT approved, or in situations exhibiting bad taste or poor judgment (i.e. alcohol, nudity, foul language) that my participation in the State Pageant may be terminated and any fees paid will be forfeited. 4. I understand that I may not wear this crown to promote any pageant system other than the Miss Universe Organization.Crown Usage Agreement* I agree to all of the terms listed above. Contestant InformationName* First Last Which Pageant Are You Competing In?*Select OneMiss Florida USAMiss Florida Teen USATitle* PhoneEmail Shipping Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Crown Type*Cost $195 Teen Miss Shipping & Insurance 5% Online Convenience Fee* Price: $0.00 Total Non-Refundable* I understand that this crown order is non-refundable. PaymentCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Cardholder's Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cardholder's Phone*Cardholder's Email* Cardholder's Signature* Δ