2017 White Privilege Conference FGC Registration

WPC18 will be held in Kansas City, Missouri from April 27th - April 30th, 2017

Email	This is my...	First Name	Last Name	Address	City	State/Province	Postal Code	Country	Phone	This is my...	Contact phone # while you are traveling	I give permission to share my contact information with fellow conference attenders

Please affirm that you understand that you need to pre-register using this form to receive the code for the FGC discount to the 2017 White Privilege Conference

TrueFalse

I confirm that I am

What Yearly Meeting do you belong to?

Monthly Meeting

Which organization?

Gender

Primary Ethnicity/Race

Other Race/Ethnicity

Date of birth

This is my first time attending an FGC event other than the Gathering

Have you attended a White Privilege Conference before?

YesNo

Are you local to the Kansas City area?

YesNo

Would you be interested in spending some time in our Quaker Hospitality room as a welcoming presence for Friends?

Are you under 18?

Parent/guardian's first name

Parent/guardian's last name

Parent/guardian email

Parent/guardian's phone

Are you attending with a youth under your care?

Name(s) of youth that are under my care

Housing while attending conference

At this time home hospitality is very limited.Will home hospitality determine your ability to attend the conference?

YesNo

	Preferred	Acceptable but not preferred	Unacceptable
Willing to sleep on a Meeting or host Friend's floor
Willing to sleep on air mattress or couch at Friend's home
Willing to share a bed at a Friend's home
Willing to share a room at a Friend's home
Willing to sleep at a Meetinghouse which does not have a shower
Willing to sleep in my own room in a Friends home

I can bring a sleeping bag

YesNo

Please let us know your housing needs (e.g. allergies, pets, smoking, accessibility, scents)

Dietary restrictions or food allergies

Other special needs that we should know about for your safety or health

Can you provide home hospitality to friends for the Conference?

What kind of sleeping accommodations can you provide?

How many Friends can you provide home hospitality for?

If available I would like assistance with transportation during the conference

Have you booked your travel?

I will be travelling to the conference by

CarBus or TrainAirplaneOther (local)

Arrival train or bus line (Greyhound, Amtrak, etc.)

Train/bus arrival time

Departure train or bus line (Greyhound, Amtrak, etc.)

Train/bus departure time

Arrival airline

Arrival flight number

Flight arrival time

Departure flight number

Departure airline

Flight departure time

Driving arrival time

Driving departure time

Will you be driving to and from the conference locally?

YesNo

I can provide transportation for other participants

How many other passengers can you accommodate?

Any transportation or logistical questions or concerns?

I plan to attend a one-day institute on Thursday, April 27th or an institute on Sunday, April 30th.

YesNo

I am planning to ask FGC for financial aid (beyond the discounted Quaker registration fee)

At this time I am planning to ask for $

in financial aid from FGC.

I am planning to ask my meeting/worship group for financial aid

I am planning to ask for $

from my monthly meeting.

I am planning to ask my yearly meeting for financial aid

I am planning to ask for $

from my yearly meeting.

If you are unable to ask your monthly or yearly meeting for financial aid, please tell us why.

Would you like to make a donation to support someone else's attendance?

Contribution amount

I would like to make my contribution by:

Please make your check out to Friends General Conference, indicate that it is a “White Privilege Conference donation” in the memo, and send to this address:

Friends General Conference

Attn: Development Office

1216 Arch St, #2B

Philadelphia, PA 19107

Cardholder name (first)

Cardholder name (last)

Credit card number

Expiration month

Expiration year

CVC or CCV code

Billing address (zip code)