First Name

Last Name

Pronouns

Gender

Primary Ethnicity/Race

Other Race/Ethnicity

Age

under 1818 or older

I will have youth who will be participating in the retreat with me.

YesNo

Please have any youth age 18 and under who will participate in the retreat register separately.

This is my first time attending an FGC event other than the Gathering.I have previously attended an FGC Retreat for Friends of Color.

What have been the formats of FGC Retreats for Friends of Color that you have attended?

Virtual retreats onlyIn-person retreats onlyBoth in-person and virtual retreats

I am affiliated with or a member of:

a Quaker Meeting (Monthly or Yearly)a Quaker Organizationneither

Name of Quaker Organization:

Meeting

Email

This is my...

Phone Number

This is my...

Contact Info for Parents + Guardians

Parent /guardian's first name

Parent / guardian's last name

Parent / guardian email

Parent / guardian's phone

I give permission to share my contact information (only parent information, in the case of a youth registrant) with fellow attenders

Fees

The registration fee for virtual attendance is $60 per person.

Confirm your registration payment below. Please note, you will not be fully registered until you completely pay your registration, either personally or with requested financial aid.

Financial Assistance

All attendees, especially young Friends, are encouraged to apply for financial assistance using this free Mahala Ashley Dickerson Fund application.
The deadline for requesting financial aid is October 12th.

Do you plan to apply for financial assistance from the Mahala Ashley Dickerson Fund?

YesNo

I am planning to ask for $

from the Mahala Ashley Dickerson Fund.

If you need financial support to attend we also encourage asking your Yearly and/or Monthly Meeting, or Quaker organization. Will you be asking for financial support to cover registration expenses related to this retreat?

YesNo

I am planning to ask for $

from my Meeting or organization.

If you are unable to ask your Meeting or organization for financial aid, please tell us why.

I understand that my registration includes a $20 deposit that will not be refunded if I cancel my registration after November 2nd.

Total amount due

$

I would like to pay by:

Credit/Debit Card Payment

Cardholder name (first)

Cardholder name (last)

Credit card number

Billing zip code

Expiration month

Expiration year

CCV code

Echeck Payment

Name on Account (first and last)

Bank Name

Account Type

CheckingSavings

Bank Routing Number

Bank Account Number

If you would like to pay by check, please make the check out to Friends General Conference, indicate that it is a “Fall 2025 Retreat for Friends of Color Registration” in the memo, and send to the address below.

Friends General Conference

P.O. Box 40844

Philadelphia, PA 19107

Please note: Due to increasingly complex security around payment fraud and requirements for foreign exchange processing, Friends residing outside of the United States are requested to pay with a credit or debit card using our online payment options.

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Participant Info

Financial Assistance