Name of Requestor

Organization Name

Phone Number

Email Address

Name of the Event

Event Date

Start Time

End Time

Event Topic or Message

Venue Name

Venue Street Address

Venue City

Venue State Venue StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Venue Zip Code

Which 2024 Crowned Queen or First Runner Up would you like to book? Which 2024 Crowned Queen or First Runner Up would you like to book?Leatha Joyner - 2024 Crowned Teen Miss Juneteenth AmericaKamryn Washington - 2024 Crowned Junior Miss Juneteenth AmericaJaelyn Brown - 2024 First Runner-up Teen Miss Juneteenth AmericaVaughn July - 2024 First Runner-up Junior Miss Juneteenth America

Purpose of Appearance Purpose of AppearanceClassroom PresentationSpeaking EngagementLocal & State CompetitionTV & Radio CommercialMedia AdvertisingGrand Opening & Ribbon CuttingParade, Exhibition, Fair, Civic CelebrationsOther

Please site your budget for accommodations, travel, transportation, and per diem (meals) you will have available for this appearance.

What is the appropriate wardrobe? What is the appropriate wardrobe? Casual Business Casual Business Semi-Formal Formal/Black Tie

Would you like her to wear her banner/sash? Would you like her to wear her banner/sash? Yes No

Would you like her to wear her crown? Would you like her to wear her crown? Yes No

Are there any media attending this event? Are there any media attending this event? Yes No

How did you hear about the Miss Juneteenth America Scholarship Pageantry Program? How did you hear about the Miss Juneteenth America Scholarship Pageantry Program? Search Engine (Google, Bing, etc.) Social Media (Facebook, Instagram, etc.) Radio/Television Interview Podcast Interview Online Article Word of Mouth Referral/Other

Please share more information about this event.

I understand that all requests are subject to approval. We do not confirm the booking of any titleholder appearances, and shall not be under any obligation to furnish the services of a titleholder, until the appearance request is approved. I understand that all requests are subject to approval. We do not confirm the booking of any titleholder appearances, and shall not be under any obligation to furnish the services of a titleholder, until the appearance request is approved. Yes, I understand.