Miss Black Ohio

Empowering our Youth Through Achievement and Success
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2011 Queens

12 in 2012 Campaign

Columbus, Cincinnati, Cleveland, and Dayton

 

Register Today!



A non-refundable one-time registration fee $50.00

 

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

 

Requirements:

We are looking for several young representatives in Ohio with a good educational background, community driven,   public interests, dedication for a good cause, interest shown towards 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 national 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)


 

 

Applicant Personal Information

(Please print clearly)

 

Name: ____________________________________________________________________________

            First                                                                   Middle                                                  Last

 

Name of Parents: __________________________________________________

 

Street Address:_____________________________________________________________

 

 

City/State/Zip_________________________________________________________

 

 

Age as of

01/01/2011: _______DOB: Month:__________ Day: __________ Year:_________

 

 

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

 

Other Phone: (     )_______________________

 

Email Address: _______________________@ Yahoo, AOL,HOTMAIL,[_______]

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

 

 

Participant Categories


Miss Black Ohio Pre Teen.. Ages 9 – 12

 

Miss Black Ohio Teen…....Ages 13 - 17

 

Miss Black Ohio Ages........Ages 18 - 2


Talent:__________________                           Category:__________________


 

* First name (required):

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

Phone number:
* Message (required):

   
Miss Black Ohio fees