Registration Information
Name
*
First Name
Last Name
E-mail
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
How will you be supporting Black & X-cellence this year?
*
Attendee
Youth Performer/ Youth Group
Vendor
Nonprofit/ Social Service Organization
Speaker
Workshop Facilitator
Sponsor
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Performer Information
Group's/ Artist's Name
How many members in your group
Give a brief description of your group (to be used in your introduction)
Person of Contact
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Website
https://www.yourwebsite.com
Social Media Info
Facebook, Instagram, TikTok, Twitter etc.
Will you require any special accommodations?
Please upload a photo to represent you or your group
Browse Files
Cancel
of
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Vendor Information
$70 Fee Includes 6 ft table and 2 chairs (Projected attendance: 300)
Business Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Are you a youth vendor (under 18)
Yes
No
What type of products do you sell?
Because this is a family-oriented event, we cannot accept submissions for adult only products
Website
https://www.yourwebsite.com
Social Media Info
Facebook, Instagram, TikTok, Twitter etc.
Will you require any special accommodations?
Please upload your logo for promotional purposes
Browse Files
Cancel
of
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Non-Profit/Social Service Table
Includes 5 ft round table and 2 chairs (Projected attendance: 300)
Business/ Organization Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
What type of services you provide?
Because this is a family-oriented event, we cannot accept submissions for adult only products
Website
https://www.yourwebsite.com
Social Media Info
Facebook, Instagram, TikTok, Twitter etc.
Will you require any special accommodations?
Please upload your logo for promotional purposes
Browse Files
Cancel
of
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Guest Speaker
Name
First Name
Last Name
Organization/ Business Name
Give a brief description of your services/ organization (to be used in your introduction)
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Do you require a fee or do you believe that the information you have to share is so vital to our community that you'll give it away for free for our event?
Yes I require a fee
No fee required
Website
https://www.yourwebsite.com
Do you require and special equipment or accommodations?
Social Media Info
Facebook, Instagram, TikTok, Twitter etc.
Please upload a photo to be used for promotional purposes
Browse Files
Cancel
of
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Mini Workshop Presenter
Name
First Name
Last Name
Organization/ Business Name
Give a brief description of your services/ organization (to be used in your introduction)
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Do you require a fee or do you believe that the information you have to share is so vital to our community that you'll give it away for free for our event?
Yes I require a fee
No fee required
Website
https://www.yourwebsite.com
Do you require and special equipment or accommodations?
Social Media Info
Facebook, Instagram, TikTok, Twitter etc.
Will you require any special accommodations?
Please upload a photo to be used for promotional purposes
Browse Files
Cancel
of
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Sponsor Information
If you do not wish to be a sponsor, please hit "NEXT"
Name
First Name
Last Name
Organization/ Business Name
What areas would you like to sponsor
Monetary Donation
Food for performers and volunteers
Giveaways for gift bags
Media Package
Other
Website
https://www.yourwebsite.com
Social Media Info
Facebook, Instagram, TikTok, Twitter etc.
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My Products
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( X )
Ticket
$
Free
If you are a participant, please hold off reserving tickets until your participation has been confirmed by our organization. Limited to 4 per person
Quantity
0
1
2
3
4
Black & X t-shirt
$
35.00
Proceed benefits The X-Perience Dance Company Scholarship Fund
Quantity
1
2
3
4
5
6
7
8
9
10
Size
---
CS
CM
CL
S
M
L
XL
XXL
XXXL
Non-profit/Social Organization
$
Free
There is to be no selling of any merchandise, products or services at these tables
Youth Vendors
$
35.00
(18 and under ONLY)
Vendor Fee
$
70.00
Monetary Gift
$
20.00
Please selection an option from below
Quantity
1
2
3
4
5
6
7
8
9
10
Donation Level
General Donation
Black
Fuchsia
Turquoise
Platinum
Enter coupon
Apply
Subtotal
$
0.00
Tax
$
0.00
Shipping
$
0.00
Total
$
0.00
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Purchase Information
Please list ALL attendees
*
Type N/A if you are the only ticket holder
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
SUBMIT
Should be Empty: