Registration: FCNL Spring Advocacy Training and Lobby Event (Mar 16, 2018 - Mar 20, 2018 )

USER INFORMATION
We will review all applications to go with us to the FCNL training. We will select up to 10 people. Our registration is open until Jan 15. We will let you know after January 20 if you have been selected.
First Name:
Last Name:
Address:
1
City:
State:
Zip:
Email:
Parents' names:
Parents e-mails:
1
Phone:
Your Quaker meeting or other faith community:
1
Birth Date:
select your current grade:
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
The following information I have given here is new:
mailing addressphone numbere-mailfood needs
Enter the amount of financial aid you are requesting from Powell House:
1
Please note here anything else we should know.:
Why do you want to go to this event?:

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