Miss Black Clarksville 2019 Contestant Application
Completion of this form is required for participation in the Miss Black Clarksville (MBC) Scholarship Program.
Email address *
Contestants Full Name *
Your answer
Parents/Guardians Name (if under 18) *
Your answer
Address *
Your answer
Phone # *
Your answer
School *
Your answer
Age Division *
Your answer
Career Goal(s)
Your answer
I agree to allow my child (myself, if 18 or older) to be photographed or video recorded for use in publications, books, visual productions, TV, and/or websites affiliated with MBC. *
I agree to pay the registration fee and participate in fundraising initiatives for the scholarship program. Mini, Little, & Junior contestant registration fee is $50. Senior contestant registration fee is $150. *
I agree to all the rules and regulations of the MBC Scholarship Program. *
Signature (parent/guardian if under 18) *
Your answer
Date *
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