On the Common Ground Enrollment Form

"Is My Anger Any Good?"

ON THE COMMON GROUND'S
NINETEENTH ANNUAL "VILLAGE OF BROTHERS" FALL RETREAT

Please Enroll Me For On The Common Ground's Nineteenth Annual Fall Retreat September 30, October 1, 2 2011. Full Donation: $160. $50 Deposit required with registration. Please make checks payable to OTCG.

Name:

Address:

City/State/Zip:

Phone:

E-mail:

Amount Enclosed:

	Full Amount ($160)

	$50 Deposit (Balance due at door)

Signature:

_____________________________

Print out this form and mail to:

On The Common Ground
c/o John Guarnaschelli
853 Seventh Ave. #5D
New York, NY 10019

For information call (212) 265 0584 or e-mail johnguarn@onthecommonground.org

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