*Pageant Name:
*No. of Years in Production:
*Date:
*First and last name:
*Email:
For U.S. & Canada Residents
Work Phone:
*Home Phone:
Cell Phone:
Fax
Additional phones
*Address:
*City:
*State/Province
*Zip code:

For Non U.S. & Canada residents:
First and last name:
Address 1:
Address 2:
State or province:
Country:
Work Phone:
Home Phone:
Fax:

Profile Information
*Gender
*Date of birth
*Age
*Highest Education level Completed:
College:
Year of Graduation:
*Job Industry:
*Occupation:

List 2 references:
     (1st Reference)
*Reference 1st & last name:
Email:
*ReferenceWork Phone:
*Home Phone:
Cell Phone:
Fax
Additional phones
*Address:
*City:
*State/Province
*Zip code:
         (2nd Reference)
*2nd Ref.1st_last name Email:
Work Phone:
*Home Phone:
Cell Phone:
Fax
Additional phones
*Address:
*City:
*State/Province
*Zip code:

*Racial Profile:
Black
Asian
Latina
NativeAmerican
White

*Have you ever been convicted of a felony: Yes No

If yes, Explain:

  MBA PROSPECTIVE AFFILIATE PARTNER:
YOU HAVE ALMOST COMPLETED THE MBA APPLICATION PROCESS. NOW YOU MUST SIMPLY SUBMIT THE PARTNERSHIP APPLICATION AND REVIEW BY THE MBAP RECRUITMENT COMMITTEE.

MBAP AFFILIATE PARTNERSHIP                    AGREEMENT

By clicking YES on the, "I agree check box" at the foot hereof, and clicking the "submit button" of this agreement, you have read and understand the rules of the Miss Black America Pageant as stated on the MissBlackAmerica.com, Web Site, and you consent and agree to be bound by all the terms and stipulations of the Miss Black America Affiliate Partnership Agreement. Therefore, you should scroll down and thoroughly read each of the following sections.

To Mr. J. Morris Anderson, Executive Producer, Miss Black America Pageant:

A. Prospective Independent Local MBA Pageant Affiliate Partner, hereinafter referred to as Partner understands the terms and conditions pursuant to your proposal stated on this web site: MissBlackAmerica.com; and, under the terms of your proposal and this agreement, desires an association with the Miss Black America Pageant, (hereinafter referred to as the Pageant). Wherein, MBAP Partner will be issued a license for the purpose of producing a MBA Pageant in association with, and under the direction of a MBAP Regional director & MBA Team Leader, all in accord with the rules and guidelines as stated in the MBA Affiliate Partner's Manual to enter a local MBAP winner into the final, National Miss Black America Pageant. It is understood that Affiliate Partner's license shall remain in effect from the date of the execution of this agreement until midnight of the day following the Miss Black America Pageant of the following year. It is understood that Affiliate Partnership may enter the contestant who wins the local pageant into the National Miss Black America Final Competition.

B. The following stipulations are understood and agreed upon:

1. That in the event Affiliate Partner is approved by MBAP Headquarters, all contractual stipulations applicable to Team Leaders will apply to MBAP Affiliate Partners.

2. That Affiliate Partnership will pay all air and ground transportation of winning Local Contestant to MBA National Finals.

3.That the Affiliate Partnership is not an employee, agent or representative of the Miss Black America Pageant; on the contrary, Affiliate Partnership is an autonomous, independent person or organization who contracts to enter its services to cause contestants to enter the Sisterhood of Miss Black America Pageantty, and send a winning contestant to the MBAP Final competition.

6. Therefore, Affiliate Partnership releases, J. Morris Anderson, The Miss Black America Pageant, and all others connected with the program in any manner whatsoever,, including, but not limited to broadcasters and sponsors from any claims arising out of injury or damage to Affiliate Partnership, in any way resulting from Affiliate Partnership's participation, or local contestant’s appearance on the pageant program. Affiliate Partnership hereby Indemnifies J. Morris Anderson, The Miss Black America Pageant, and all those described above ands holds them harmless from all liability, claims, actions, damages expenses and losses of any nature whatsoever caused by or arising out of any statement or actions of Affiliate Partnership, or local contestant made in or in connection with Affiliate Partnership's participation, Local Pageant’s participation, or Local Pageant's Winning Contestant's participation in the Miss Black America Pageant & Media Event.

7. In the event this agreement is executed by the parties, it is made subject to all federal, state and municipal laws or regulations now or hereinafter in force, and shall be construed according to the laws of the State of Pennsylvania. Any litigation arising from the stipulations set forth herein shall fall under the laws of Pennsylvania, and shall be adjudicated within the State of Pennsylvania.

*I AGREE with the stipulations herein above stated and agree to abide by same:     *YES I AGREE

*Name of Prospective Affiliate Partner Accepting Terms
of Contract Providing agreement is accepted by MBAP :