Adelynrood Scholarship Application

* These fields are required

1 Welcome

2 People in your group

Guest 1		First Name* Last Name* Email* Phone
Guest 1		First Name* Last Name* Email* Phone

3 Participant Info

Address
Address 2
City
State/Prov.
Zip/Postal
Country
Which Conference/Program are you planning on attending? *	Please note: This is not your registration form.
What are you requesting for this Scholarship? *
How much are you requesting? *	Total of all.
Your thoughts on how a scholarship to Adelynrood will be meaningful to you are appreciated by our membership for planning purposes and ongoing support for these funds. *
How will an Adelynrood scholarship help you *	Your answers are appreciated by our membership for planning purposes and ongoing support for these funds.
How did you hear about our scholarship program? *
Please check a that apply *

	By submitting payment, you authorise Adelynrood to send instructions to the financial institution that issued your card to take payments from your card account in accordance with the terms of Adelynrood's agreement with you.