CONTACT INFORMATION

School Name / Organization*

Name of Registration Contact/Division Head *

This person will be contacted with questions about participants or registration information.

Registration Contact/Division Head Day Phone # *

(include area code)

Registration Contact/Division Head Email Address*

PARTICIPATION INFORMATION

How many participants would you like to register? *

PARTICIPANT ONE

Name*

What name does the participant go by?*

(example William = Bill, Kathleen = Kathy

Participant "Weather/Travel Emergency" contact/cell number:*

(In case of last minute cancellations, lateness or travel advisories) Cell phone preferred

In what Division/Department does participant work?*

What is the participant's job title/subject taught?*

What is the participant's E-mail address?*

What pronoun does the participant use?*

(example: She/He/Them etc.)

There are a limited number of single rooms. For the purpose of assigning participants to a shared room, Friends Council asks that you indicate how each participant self identifies. This information will be confidential.

Friends Council will place those who identify as male together in a shared room and those who identify as female in a shared room.

Food allergies, special requirements? *

Please explain.

While Pendle Hill is able to accommodate a wide variety of dietary needs, all foods are prepared in the same kitchen. We prepare delicious gluten-free fare for those who prefer not to eat gluten, but our kitchen is not gluten free. Those who have been diagnosed by a doctor with a life threatening food allergy, such as celiac disease, should consider supplementing our meals. Staff is available to discuss individual needs in advance of your arrival.

Does particpant have any physical restrictions, special accommodations needs or any other comments:*

Yes No

Please share any information here

Registration Options*

Financial Assistance Criteria

If your school has:

fewer than 250 students
or more than 400 miles to travel to the workshop site
and you need financial assistance to attend one of our workshops or peer network events.

Financial assistance is limited and will be offered on a first-come, first-served basis.

Contact Friends Council office if you have questions.

PARTICIPANT TWO

Name*

What name does the participant go by? *

(example William = Bill, Kathleen = Kathy

Participant "Weather/Travel Emergency" contact/cell number:*

(In case of last minute cancellations, lateness or travel advisories) Cell phone preferred

In what Division/Department does participant work?*

What is the participant's job title/subject taught?*

What is the participant's E-mail address?*

What pronoun does the participant use?*

(example: She/He/Them etc.)

There are a limited number of single rooms. For the purpose of assigning participants to a shared room, Friends Council asks that you indicate how each participant self identifies. This information will be confidential.

Friends Council will place those who identify as male together in a shared room and those who identify as female in a shared room.

Food allergies, special requirements? *

Please explain.

While Pendle Hill is able to accommodate a wide variety of dietary needs, all foods are prepared in the same kitchen. We prepare delicious gluten-free fare for those who prefer not to eat gluten, but our kitchen is not gluten free. Those who have been diagnosed by a doctor with a life threatening food allergy, such as celiac disease, should consider supplementing our meals. Staff is available to discuss individual needs in advance of your arrival.

Does particpant have any physical restrictions, special accommodations needs or any other comments:*

Yes No

Please share any information here*

Registration Options*

Financial Assistance Criteria

If your school has:

fewer than 250 students
or more than 400 miles to travel to the workshop site
and you need financial assistance to attend one of our workshops or peer network events.

Financial assistance is limited and will be offered on a first-come, first-served basis.

Contact Friends Council office if you have questions.

PARTICIPANT THREE

Name*

What name does the participant go by?*

(example William = Bill, Kathleen = Kathy

Participant "Weather/Travel Emergency" contact/cell number:*

(In case of last minute cancellations, lateness or travel advisories) Cell phone preferred

In what Division/Department does participant work?*

What is the participant's job title/subject taught?*

What is the participant's E-mail address?*

What pronoun does the participant use?*

(example: She/He/Them etc.)

There are a limited number of single rooms. For the purpose of assigning participants to a shared room, Friends Council asks that you indicate how each participant self identifies. This information will be confidential.

Friends Council will place those who identify as male together in a shared room and those who identify as female in a shared room.

Food allergies, special requirements? *

Please explain.

While Pendle Hill is able to accommodate a wide variety of dietary needs, all foods are prepared in the same kitchen. We prepare delicious gluten-free fare for those who prefer not to eat gluten, but our kitchen is not gluten free. Those who have been diagnosed by a doctor with a life threatening food allergy, such as celiac disease, should consider supplementing our meals. Staff is available to discuss individual needs in advance of your arrival.

Does particpant have any physical restrictions, special accommodations needs or any other comments:*

Yes No

Please share any information here*

Registration Options*

Financial Assistance Criteria

If your school has:

fewer than 250 students
or more than 400 miles to travel to the workshop site
and you need financial assistance to attend one of our workshops or peer network events.

Financial assistance is limited and will be offered on a first-come, first-served basis.

Contact Friends Council office if you have questions.

FEES & PAYMENT

Total registration fees for this registration. Hit submit for payment options.