2017 Scholarship Application (Survivors & Loved Ones Only)

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* 1. Contact Information (This information and all info below is confidential and for application purposes only. We will not share this information with anyone, and it will NOT appear on any event publications, name tags, etc)

First Name:

Last Name

Email Address (to receive your access code for discounted registration)

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* 2. Which event or events are you applying for scholarships to attend?

An Evening with Marilyn on 9/8

Race for Healing on 9/9

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* 3. Why would you like to attend the event(s) you selected? (150-200 words)

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* 4. Please briefly describe the financial need that is prompting your scholarship request. (50 words max)

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* 5. How much would you feel comfortable contributing toward registration?
(Regular price to attend the dinner is $50 and the race is $20. If you would like to do both events then the dinner cost is discounted to $40)