Please register me for these conferences. I have enclosed a $20 deposit for each conference.
I understand registrations cannot be processed without a deposit.

#of Conferences Registering for ___ Total Deposit Enclosed ($20 per conference) $_____

Name______________________________ Monthly Meeting _________________________

Address __________________________ City______________ State______ Zip__________

Phone _______________ Birth Date ___________ Grade_______ Gender _________

Youth E-Mail Address ____________________________________
New Mailing Address ____   New Phone___  Medical Concerns*___
No Red Meat___   Vegetarian___   Vegan___  Food Allergy*___

*Please Explain___________________________________________________

_______________________________________________________________

Travel
Car Driven by Adult____ Include my name on Carpool List_____
Car Driven by self or other youth attender______
Train at Hudson at 5:45 pm _____    Train at Albany/Rensselaer at 7:05 pm _____

Scholarship
$30 First Timer Discount_______ or
Requesting $_______per conference in financial assistance

I am enclosing a $________ donation to help others attend Powell House.