Registration: Wild Edibles I - 3rd - 5th grade with a parent (Jun 14, 2019 - Jun 16, 2019 )

USER INFORMATION
Select your payment level:
Coming as a child-adult pair ($100)  
Just the child, but getting multiple conference rate ($130)  
Just the child, just this one conference ($160)  
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First Name:
Last Name:
Address:
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City:
State:
Zip:
Email:
Parents' names:
Parents e-mails:
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Phone:
Your Quaker meeting or other faith community:
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What is your grade? (for the coming school year ):
3rd grade  4th grade  5th grade  adult  
Birth Date:
Gender:
Note any other concerns we should be aware of (health, accesibility, etc.):
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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:
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TRANSPORTATION: Would you like to be included on the carpool list? The list is sent to people who are on it.:
yes  no  
The following information I have given here is new:
mailing addressphone numbere-mailfood needs
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)  
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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).
Enter the amount of financial aid you are requesting from Powell House:
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Please note here anything else we should know.:
My monthly meeting will pay for my registration (You will not have to pay the deposit on the web site.):
Ithaca - youth conference  
Rahway- Plainfield - all ages  
other meeting will pay (put the meeting or committee name & the amount they will be paying in the comment box)  
Ooops, I clicked one of the above buttons and then it wouldn't un-click so this button says just ignore the other one.  
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TO SIGN UP 2nd PERSON: * FINISH the form and click "Next Step" * REVIEW the confirmation page and change the amount if paying more than the minimum * * CLICK "next step" ** CLICK the button "Register for Another Event" *** SELECT the same event again. The form will open with all the information from the first person. CHANGE the name and other information as needed.

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