Miss Black Georgia USA Pageant Program Book Ad Order Form
All fees paid the Miss Black Georgia USA Pageant presented by A. Van Dyke Productions are NON-REFUNDABLE OR TRANSFERRABLE.
Name
*
First Name
Last Name
E-mail
*
Phone Number:
*
-
Area Code
Phone Number
Name of Business (As you want it printed in the Program Book)
Ad Text
*
Contestant Name (if you are buying an ad to support a contestant).
First Name
Last Name
Ad Page Options
*
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( X )
Full Page Ad
$
100.00
Standard 8.5 X 11 Page Ad
Half Page Ad
$
80.00
Quarter Page Ad
$
55.00
Total
$
0.00
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By clicking the "Pay Now" button you are submiting your online application and will be re-directed to Paypal to submit your payment. Once we recieve your payment, we will contact you about your Membership.
Thank you!
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