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:

*Name of Event:

*Dates:

to *Year

*Time Day One:

*Time Day Two:

Time Day Three:

Time Day Four:

Time Day Five:

*Travel Dates:

to *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 Guests(VIPs):

*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