Applications

2010-2011 Miss Black Ohio Pageant

Looking for 5 Representatives from Cleveland, Cincinnati, Dayton, Toledo, and Columbus to become delegates in the 2010-2011 Miss Black Ohio pageant. We are limiting our selections to only 5 young ladies to represent their great city. Do you have what it takes?

Register Today!

*Sponsorship is available through the following sources:

family, friends, coworkers, schoolmates, church and community affilations

A non-refundable one-time committment fee of $225*

Deadline for registration is *January 31, 2010

no-refunds, cash – cashier checks – money order- paypal CAN be accepted as payment toward fees

Requirements:

We are looking for strong representatives in Black Ohio with a good educational background, community driven, public interests, dedication for a good cause, interest shown towards the human rights and the well-being of mankind, well spoken, self-motivated and a hard worker. Finalist in the Miss Teen and Miss categories will move on to compete in a State-wide competition and the Miss Black America USA pageant.

_______________________________________ __________________

Signature of Applicant Date

________________________________________

Printed Name of Parent or Guardian

(If applicant is under 18 years of age)

________________________________________ ________________

Signature of Parent or Guardian Date

(If applicant is under 18 years of age)

Categories

Please note as of 1-1-10 SOME OF OUR CATEGORY TITLES HAVE CHANGED TO REFLECT A GREATER DEMOGRAPHIC

Miss Black Ohio Princess…… Ages 4 – 6

Miss Black Ohio Little Miss.… Ages 7 - 9

Miss Black Ohio Pre Teen…… Ages 10 – 12

Miss Black Ohio Teen………… Ages 13 - 17

Miss Black Ohio Ages............ Ages 18 - 27

Miss Black Ohio American Beauty Plus Ages 28+ (NEW)

Applicants Personal Information

(Please print clearly)

Name: ____________________________________________________________________________

First Middle Last

Name of Parents: __________________________________________________

Street Address:_____________________________________________________________

City/State/Zip_________________________________________________________

Age as of

01/01/2009: _______DOB: Month:__________ Day: __________ Year:_________

(background check mandatory for contestant over the age of 18 years of age)

Home Phone: ( )_________________ Other Phone: ( )__________________

Other Phone: ( )_______________________

Email Address: ____________________@ Yahoo, AOL,HOTMAIL,[__________]^other

(email address is mandatory and can be obtained free at yahoo, hotmail, or other providers)

Talent:__________________ Category:__________________

* First name (required):

* Last name (required):
* E-mail address (required):

Phone number:
* Message (required):

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Miss Black Ohio

Empowering Young Minds Through Achievement and Success