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LEAAD- Leadership Empowering African American Development

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Miss Black Fresno
ONLINE APPLICATION

First Name

Last Name

Age

Date of Birth

Home #

Cell #

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Eye Color

Hair Color

Weight

Height

Dress Size

Shoe Size

High School

College

Major

Email

Community Service & Activities

Do you have a Facebook page? If so what is it under?

Do you have an Instagram page? If so what is it under?

How did you hear about our event?

Thank you for helping us make a difference!

LEAAD- Leadership Empowering African American Development

Phone #: 559-287-4581 • Email: viva@leaadnow.org

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