Miss Black Clarksville Scholarship Program Advertisement Form
Please complete this form in order to place an ad in the 2019 Miss Black Clarksville Pageant souvenir book.
First and Last Name:
Business/Company Name (if applicable):
Address, City, State, Zipcode:
Ad prices and sizes are indicated below. Please check the appropriate box:
Full Page $100.00
Half Page $50.00
1/4 Page $35.00
Business Card $25.00
What would you like stated on the ad? (For example: "Congratulations," "All the best," etc.)
Are you using pictures, business cards, or graphics for your ad? If so, please email them to
upon submission of this form.
I, the applicant, consent to the use of advertisement as described in this form for use in the Miss Black Clarksville Scholarship Program 2019 souvenir book. I will make a payment upon submission of this form according to the price of the ad selected above:
Send me a copy of my responses.
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