First name(s)*:

Family name*:

Age Range*: Under 18 18-35 36-60 61-75 76-90 Over 90

If under 18, please enter exact age:
Age:

Gender*:

Quaker Meeting/organisation*:

Representative*: Yes No N/A

Membership*: Yearly Meeting Member Monthly Meeting Member International Member Attender/Friend of Friends N/A

Email address*:

Country*:

Postal address:

Phone number (landline):

Mobile number:

Skype name:

First language*:

Please select from the boxes below:

English*: None Basic Confident Fluent Willing to translate

French*: None Basic Confident Fluent Willing to translate

German*: None Basic Confident Fluent Willing to translate

Russian*: None Basic Confident Fluent Willing to translate

General dietary requirements*: Omnivorous Vegetarian Vegan Other

Specific dietary requirements:

Gluten-free    Dairy-free    Other

If Other, please specify:

Details of any food allergies:

Accommodation preferences*: Single Single en-suite Twin Twin en-suite Multiple Non-resident

Name of person you may like to share room with:

Room-share with:

N.B We will do our best to meet your preferences if possible, and will inform you if not possible.

I would like to stay on the night of the 1st May (there will be an additional charge for this)*: Yes No

Accessibility requirements:

Bursary requirements:

N.B For bursaries, please approach your Meeting/organisation first. We will try to give assistance when no other source of funding is available.

If you want to support our bursary fund, for other people to participate, please enter a figure below:

Donation to bursary:

If you want to support our work in general, please do so via our donations page