Miss Black USA - Scholarship Pageant

Request Miss Black USA

Thank you for your interest in booking Miss Black USA. Please fill out the questions below with the most accurate information. Once we review the information we will contact you regarding your request. This form is a REQUEST ONLY and does NOT confirm any participation in an event or appearance.

Again, thank you for your interest!

ALL FIELDS WITH * MUST BE FILLED OUT OR YOUR REQUEST WILL NOT BE PROCESSED.

*Name:
*Title:
*Organization:
*Address:
Address:
*City:
*State:
*Country:
*Zip Code:
*Phone Number:
*Fax Number:
*Email:
*Mobile Number:
*Name of Event:
*Dates Requesting:	through Year
*Time Day 1:	through
Time Day 2:	through
Time Day 3:	through
Time Day 4:	through
Time Day 5:	through
*Travel Dates:	through Year
*Description of Event:
*Titleholder Duties:

*Is your Organization a Not For Profit?:	YES NO
*Will the proceeds from this event benefit a charity?:	YES NO
If Yes, please provide the name of the charity.
Address of the Charity
Type of Charity:
*Confirmed Guest (celebrities, sports figures, public figures, etc.)

*Approximate Number Of People Attending
*Do you have a Public Relations Firm?	YES NO
If Yes, please provide Contact Name
Pulbic Relations Contact Number
*Media Attending