Registration: Downtown Meditation Community Retreat (Mar 30, 2017 - Apr 7, 2017 )

USER INFORMATION
First Name:
Last Name:
Address:
1
City:
State:
Zip:
Email:
Phone:
Would you like to be included on the carpool list? The list is sent to people who are on it.:
yes  no  
Check any of these restrictions that apply (you may explain details in the next box):
vegetarianveganallergy-specify belowno gluten
Explain any specific food needs or things that the cook should know:
1
Your Quaker meeting or other faith community:
1
Note any concerns we should be aware of (health, accesibility, etc.):
1
Enter the amount of financial aid you are requesting from Powell House:
1
The following information I have given here is new:
mailing addressphone numbere-mailfood needs
Please note here anything else we should know.:
The deposit amount will appear automatically on the confirmation page. You may change the amount by typing in what you want to pay at this time (above the minumum deposit).