We Rock! Application 2020 GRA Rock Retreat Application Step 1 of 2 50% Please fill out this application to attend the GRA Rock Retreat, Presidents' Day Weekend, February 15th-17th, 2020. Camp will be held at Griffin School, 5001 Evans Ave, Austin, TX 78751. Showcase on Monday, February 17th (location TBA). Please remember that applications are not complete until payment is made. If you need to discuss a payment plan, or have any other questions regarding your enrollment, please email Jamie Bahr at Jamie@girlsrockaustin.org Thank you!Section BreakLegal Name* First Last Preferred/Personal Name* Preferred/Personal Name If you have another name you'd like to go by, please enter here. If N/A please write N/A.Gender Pronouns She, her, hers He, him, his They, them, theirs Please check all that apply.Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Emergency Contact 1 Phone* Please list any dietary allergies, restrictions, or needs:* Is this your first time attending Girls Rock Austin?*YesNoHow did you hear about Girls Rock Austin?*Are you applying with a friend, for the friend rate of $500/2 campers?*YesNoIf you are applying for the friend rate, please list the name of the person applying/attending with you.*Please write your first instrument choice (guitar, bass, drums, keys and vocals).*Please write your second instrument choice (guitar, bass, drums, keys and vocals).*Please write your third instrument choice (guitar, bass, drums, keys and vocals).*Please describe what, if any, experience you have playing music. Experience isn't necessary, we love teaching beginners!!*Camper Tuition*Early BirdStandardBring a Friend SpecialPlease note in order to receive the "Early Bird" rate, your application must be completed and submitted by December 31st, 2019. To receive the "Bring a Friend Rate," you and your friend must both indicate that you are coming together, by writing this on the application or contacting us at jamie@girlsrockaustin.org.Total $0.00 Payment Type*Credit CardMail-in CheckSelect how you'd prefer to pay, either credit card or checks made and mailed to: Girls Rock Austin PO Box 300897 Austin, TX 78703Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name