Beyond Pink and Blue

This event has only 26 space(s) left. If you continue and register more than 26 people (including yourself ), the whole group will be wait listed. Or, you can reduce the number of people you are registering to 26 to avoid being put on the waiting list.

How many people are you registering? *

(including yourself)
Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Review your registration".

Youth Program Registration

Please complete the form for the individual(s) actually attending the event.

Attendee First Name *

Attendee Last Name *

Street Address *

City *

State *

Postal Code *

Email *

Parents' Names

This parent email will be the one that gets copied on emails to the youth.

Parent e-mail

Thee parent emails below will be added to the youth's record as well so we can get hold of each parent as needed

Additional parents' e-mails

Phone *

Quaker Meeting or other faith community

Our programs are open and welcoming to people of all faiths.

Birth Date *

What year will you graduate high school?

Graduation Year *

Gender *

If needed, please explain in more detail below.

Food Restrictions

Vegetarian	Vegan	Gluten Free	Dairy Free
Nuts (specify in the text box)	Other Allergy

We will do our best to meet your requirements or make you aware of our limitations.

Food Restriction Notes

Any other concerns we should be aware of (health, accessibility, etc.)

Other needs

If you prefer, please feel free to call us and discuss your needs and concerns.

Financial Aid Request

Enter the amount of financial aid you are requesting from Powell House.

Would you like to be included on the carpool list? The list is distributed in advance of the event to people who have expressed interest.

Carpool Interest?

Yes No

I am planning to arrive by train and would like to be on a list of people willing to share a taxi.

Shared Taxi?

Hudson Amtrak (from NYC)

Albany Amtrak (from the west)

If you have indicated that your monthly meeting will pay for your registration, please indicate which meeting you belong to. If you have selected Other, please indicate the name of the meeting in the comments box.

Monthly Meeting Sponsorship

Ithaca - Youth Conference

Rahway-Plainfield - All Ages

Other Meeting

Additional Comments

Event Fee(s)

Registration Fee *

Standard Rate - $ 220.00

First Time Youth Rate - $ 160.00

Multiple Event Signup - $ 180.00

Monthly Meeting Sponsorship - $ 0.00: Please indicate which meeting will be covering your registration fee.

Financial Aid Request - $ 0.00: Please indicate under "Additional Comments" how much Financial Aid you would like to request

Late Registration

Late Fee - $ 20.00: Click here if one week or less before the conference

- none -

Donation (Will be added to minimum deposit)

$25 $50 $75 $100 $125 - none -

Make a donation to help offset the actual cost of youth conferences.

Total for this participant

Payment Options

Payment Method

PayPal/Credit Card I will send payment by check or online