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Powell House Adult Online Registration Form


  1. Use this form to register online for any adult conference. (Do not use this form for Youth Conferences Registration.)
  2. Click "continue" at the end of the form to choose a payment method.
  3. If you have questions please refer to our calendar , our FAQ page, or contact us .
•DENOTES REQUIRED FIELD

REGISTRATION INFORMATION
•
NAME OF CONFERENCE
•
CONFERENCE DATE
   
•
FIRST NAME:
•
LAST NAME:
   
•
STREET ADDRESS:
•
CITY:
   
•
STATE:
•
ZIP:
   
•
TELEPHONE (Home):   TELEPHONE (Work):
   
•
E-MAIL ADDRESS:   FRIENDS MEETING:
   
• NUMBER OF PEOPLE REGISTERING:
Adults
Children (2-17)
Infants
 
  Names of other adults or teens on this registration, if you are registering more than one person (list children 12 and under in child care section)
CHILD CARE NEEDS
 
Child care Needed?
Crib needed?

Child/ren Name(s) and Age(s):
SPECIAL INFORMATION
 

VEGETARIAN? (Note: Vegetarian options often include eggs or dairy products. If you are on a more limited diet, we suggest that you bring your own food supplements.)

Food allergies, comments, other special needs, etc.

* Please note: NO DOGS OR OTHER PETS ARE ALLOWED AT POWELL HOUSE.