The Farmington-Scipio Regional Meeting Directory Form
Before entering your directory information below, please read the guidelines and use restrictions found at http://www.directory.quakerwny.com
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Welcome!
Please note that your name and place of worship are required. The rest is optional. Enter only the information you wish to share.
Your First Name *
Your Last Name *
Your Meeting (Worship, Monthly, Preparative) *
Street Address; Line 1
Street Address; Line 2
City
State
Zip Code (Plus 4 if you know it...)
Your PRIMARY Email Address
Your SECONDARY Email Address
Your PRIMARY Phone/Cell Number (including area code!)
Your SECONDARY Phone/Cell Number (including area code!)
Your Birth Year
Full Name of Your Significant Other
Full Name(s) of Your Child(ren)
Tell us a little about yourself!
The section below is for you to share your interests, concerns, and committee work with the region. Please keep your responses BRIEF! (No more than ten words each.) And put only ONE interest / concern / committee in each box. Again, the text you enter will be dropped directly into the directory, so be extra careful to spell everything correctly!

PLEASE DO NOT USE PARAGRAPH MARKS / RETURNS.  JUST ONE LINE IN EACH BOX!  THANK YOU!!!
Committee / Concern / Interest 1
Committee / Concern / Interest 2
Committee / Concern / Interest 3
Gifts to Share!!
Do you have a gift you'd be willing to share?  E.g.,  computer skills, gardening, sailing, xylophone!  PLEASE DO NOT USE PARAGRAPH MARKS / RETURNS. JUST ONE LINE! THANK YOU!!!
Thank you!
The Directory Coordinator will confirm the receipt of your information.
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