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
*
Performer (19 or younger ONLY)
Volunteer
Sponsor
Attendee
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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?
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Vendor Information
Fee Includes 6 ft table and 2 chairs (Projected attendance: 300)
Business Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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?
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Non-Profit/Social Service Table
Includes 6 ft 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?
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Presenter Information/ 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 give it away for free?
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?
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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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Purchase Information
My Products
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( X )
Ticket
$
Free
Limited to 4 per person
Quantity
0
1
2
3
4
Monetary Gift
$
Free
Please selection an option from below
Quantity
1
2
3
4
5
6
7
8
9
10
Donation Level
---
Black
Fuchsia
Turquoise
Platinum
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
SUBMIT
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