Name as it appears on the credit card you will be using for this purchase
*
This rose is being donated by...
First Name
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Last Name
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Address
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City
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State
*
Zip
*
Phone
*
E-mail
Donation Type
Friendship Rose
Memory Rose
Occasion for Giving the FRIENDSHIP Rose
Or, if a MEMORY ROSE... in Memory of
Note - that you will have the opportunity to select the number of rose(s) after you have submitted this form and have arrived at the PayPal site. -- Please continue the order process by providing the contact information for the individual(s) who should be notified of your gift.
Name of recipient... Please Notify
*
Address
*
City
*
State
*
Zip
*
Phone
*
E-mail
Other Instructions or Comments
Thank you for telling us where you learned about our “Love Is A Rose” opportunity. Select one of the following:
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Used before
I'm a KCRS member
A friend
KCRS website
Facebook
KCRS event
Lyric Opera
Kansas City Ballet
KC Repertory Theatre
Magazine / Newspaper ad
Security Code
*
(Please click the Submit button only once; do not double click.)
After you click submit, you will be taken to our PayPal page where you will begin the payment process. Then, once you arrive at the secure PayPal site, you will be able to select the number of rose bushes you want to purchase and provide your credit card information. -- THANK YOU!