Registration: Unwinding 9th -12th grade (Jul 13, 2017 - Jul 16, 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  
Gender:
Birth Date:
select your current grade:
1
Parents' names:
Parents e-mails:
1
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
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
Your Quaker meeting or other faith community:
1
Note any concerns we should be aware of (health, accesibility, etc.):
1
I would like the first time attender youth discount:
yes  
1
My monthly meeting will pay for my registration:
Ithaca - youth conference  Rahway- Plainfield - all ages  other meeting (put meeting name and amount in the comment box)  
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).