Registration: Story Fire...a Retreat for Parents (Mar 2, 2018 - Mar 4, 2018 )

USER INFORMATION
First Name:
Last Name:
Address:
1
City:
State:
Zip:
Email:
Phone:
Your Quaker meeting or other faith community:
1
Note any other concerns we should be aware of (health, accesibility, etc.):
1
FOOD: 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
Do you need child care?:
1
The following information I have given here is new:
mailing addressphone numbere-mailfood needs
TRANSPORTATION: Would you like to be included on the carpool list? The list is sent to people who are on it.:
yes  no  
I am planning to arrive by train and would like to be on a list of people willing to share a taxi:
Hudson Amtrak (from NYC)  Albany Amtrak (from the west)  
1
If you do not make the minimum deposit on the next page, then YOUR REGISTRATION WILL NOT BE SAVED. We won't even know you were here. You must call or email us if you are not going to pay the minimum deposit. ( If the amount in the deposit line is $0, then it will be saved. )
Choose the fee level that applies to you. ($20 late registration fee will be added starting 3 weeks before an event)::
Adult  age 13-22  under 13  commuter adult  
Enter the amount of financial aid you are requesting from Powell House:
1
Discount for parent attending this event while your kid is at a youth conference:
yes  
1
MONEY : 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).
Please note here anything else we should know.:

Powell House is the conference and retreat center of the 

New York Yearly Meeting of the Religious Society of Friends (Quakers).

Powell House
524 Pitt Hall Rd
Old Chatham,  NY
12136
phone  518-794-8811
fax     518-794-8815
Adult Program 
sharon@powellhouse.org
regina@powellhouse.org
Youth Program
chrisandmike@powellhouse.org