~ Registration Form (one for each Friend) ~

Meeting for Discernment

Brooklyn Meetinghouse

110 Schermerhorn Street, Brooklyn, NY 11201

At Adams Street (Boerum Place)

Saturday, March 2, 2013 from 9:00 a.m. – 5:00 p.m.
(with optional time in the evening for reflection)

Registration deadline for childcare & home hospitality: February 15, 2011

Please send registration forms to NYYM, 15 Rutherford Pl., New York NY 10003
or or register online at www.nyym.org

Directions are online at http://brooklynmeeting.org/directions.html

Host committee contacts for questions or more detailed information:

Sally Campbell 212 787-3903

On March 2 ONLY, call the Meetinghouse, 718-625-8705

Name
Phone (land) / Phone (cell)
Email
Meeting
Are you appointed by your meeting to attend the meeting for discernment?

If you are an appointee and have questions or wish to request financial assistance, please contact
Lucinda Antrim, 30 Luzern Rd., Dobbs Ferry, NY 10522 (914) 693-2083 or

Childcare needs? Name and age of each child: Requests MUST be rec’d by 2/15/13
Dietary needs: / Vegetarian / Vegan
Other dietary requirements:

The host committee cannot guarantee to meet all special dietary requirements.
Please indicate if you prefer to bring your own food. Limited refrigerator space will be available.

Overnight hospitality with local Friends needed? Requests MUST be rec’d by 2/15/13
I have arranged to stay with:
I would like hospitality for: / Fri night / Sat night / Can bring sleeping bag
Special needs for lodging: / Smoker / Stairs a problem / Vegetarian
Allergies / Other
I am traveling with (below) and we would like to stay together:
I will be arriving by plane: / or train: / And would like to be met at the airport or station, if it’s possible to arrange

For mass transit arrangements, PLEASE CONTACT TOM ROTHSCHILD AFTER FEBRUARY 20 718-488-9001.

• OTHER SPECIAL NEEDS (attach note if necessary)

• $10 donation suggested (more if you can, less if you can’t) towards food, childcare, etc.
Please bring cash to pay on the day—do not send money with form.

If the weather seems questionable, please contact the office on Friday the 1st (, 212 673-5750), or call one of the host contacts named above.