White Rose Ball 2020 Welcome to the registration wizard. Please answer the following questions and you will be directed through the registration process. I would like to...*--- Please Select ---Register As An EscortRegister A Father & DaughterMake A Donation OnlyRequest A ScholarshipHow Many People In Your Party?*---- Please Select ----OneTwoThreeFourFiveTo apply for the scholarship, please fill out all information and requirements and email them to email@example.com Save and Continue Later General InformationFull Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Mother's Email Mother's PhoneHow Did You Hear About White Rose Ball?*--- Please Select ---Attended BeforeA Friend / Family MemberSearch EngineSocial Media (Facebook, Instagram, Twitter)Church AnnouncementSchool AnnouncementOtherIf You Attend A Church, Please Let Us Know Where. Save and Continue Later Father/Escort InformationSurname*Mr.Dr.Rev.First Name*Last Name*Email* Mobile Phone* Save and Continue Later First Female AttendeeFirst Name*Last Name*School Attending*Current Grade*--- Please Select ---7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeOtherEmail Mobile Phone Save and Continue Later 2nd Female AttendeeFirst Name*Last Name*School Attending*Current Grade*7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeEmail Mobile Phone Save and Continue Later 3rd Female AttendeeFirst Name*Last Name*School Attending*Current Grade*7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeEmail Mobile Phone Save and Continue Later 4th Female AttendeeFirst Name*Last Name*School Attending*Current Grade*7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeEmail Mobile Phone Save and Continue Later Here are the instructions for uploading scholarship essay. Upload Files Drop files here or Save and Continue Later I would like to choose a photo package.*No, Thank youPhoto Package APhoto Package BPhoto Package C*Includes $7.50 Shipping Charge Photo Package A Package A includes: Two 5x7, and Two Mini Snapshots of your choice. Proofs provided. Cost: $25Photo Package B Package B includes: Four 5x7's and Four Mini-Snapshots Cost: $35Photo Package C Package C includes: One 8x10, Four 5x7, Fouf Mini-Snapshots. Proofs provided. Cost: $45 Save and Continue Later Finalize Registration Thank you for your registration. You will receive a registration email and a receipt for your purchase to the primary registrant email. We will also notify you via email regarding any further instructions and information.Total Charges Price: $0.00 Would you like to make a donation?*NoYesPlease Enter Your Donation Amount Payment Method*CreditCardCheck / Purchase OrderScholarshipCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Checks should be received no later than 15 days after registration. Checks not received by May 20, 2020, must be presented in person at the conference in order to gain entry. Please enter your PO number in the space below for reference. You will be notified when payment is received via email. PO NumberEnter the coupon code you were provided when your application for the scholarship approved via email. Discount Code Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.