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.
Email address *
First and Last Name: *
Your answer
Business/Company Name (if applicable):
Your answer
Address, City, State, Zipcode:
Your answer
Phone Number:
Your answer
Contestant's Name: *
Your answer
Ad prices and sizes are indicated below. Please check the appropriate box: *
Required
What would you like stated on the ad? (For example: "Congratulations," "All the best," etc.)
Your answer
Are you using pictures, business cards, or graphics for your ad? If so, please email them to missblackclarksville@gmail.com upon submission of this form. *
Required
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: *
Required
Signature: *
Your answer
Date: *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service