The Annual Black & White Scholarship gala
online registration

Please fill out Information below
Fields Marked with * are Required
*Full Name
Full name of guest
*Address
*City
*State
*Zip Code
*E-mail
* Phone Number
(555)555-5555
Do you have any dietary restrictions?
*Dinner Choice (Guest 1 Required)
Guest 1: Guest 2:
*I would also like to sponsor Books & Beyond Scholarship at $500 each.
*Sponsorship Levels
If selecting the sapphire sponsorship level, please indicate the amount of the donation.
*If selecting a sponsorship, please list name(s) to appear in program
Please contact me, I would like to donate an auction item.
Yes No
Please list the names of the people in your party (seating is in tables of 10) attending the gala. We will do our best to accommodate your request.