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Or Print and Fax to: 510.346.8635 Or Register by phone 510.835.0655
Or register by E-mail: 33dennis@sbcglobal.net
Rev. Matthew Fox, PH.D
Occupy Christianity, A New Reformation:
Creation Spirituality and the Transformation of Christianity
A weekend retreat for Spiritual Activists
May 25 – 27, 2012 Friday-Sunday
Adelynrood Retreat Center, Byfield, MA
First & Last Name _________________________________________________
Address _________________________________________________________
Home Phone _____________________________________________________
Cell Phone _______________________________________________________
E-mail ___________________________________________________________
Emergency Contact Name __________________________________________
Phone ___________________________________________________________
Vegetarian? Yes _________ No_________
Other dietary restrictions/allergies? ___________________________________
ACCOMMODATIONS ARE LIMITED FOR THOSE WITH DISABILITIES. PLEASE DESCRIBE MOBILITY CHALLENGES: ______________________________________________________________________
____________________________________________________________________________________
Fee: $395 (Includes 2 nights lodging, 6 meals and tuition)
$100 deposit confirms your registration
Balance of $295 due May 1, 2012
Early Bird Special: $377.50 Register and pay in full by Feb 1 and receive 10% discount on tuition and a copy of “A New Reformation” by Matthew Fox (a $30 value)
Full Payment Registration $395 Register and pay in full by April 1 and receive a complimentary copy of “A New Reformation”
I am paying by check: Amount enclosed $ ________
Credit Card(Visa, MC or Amex): Amount of Payment $________
Card # ___________________ Exp. Date: ______________
Signature ____________________________________
Tax-deductible gift enclosed for scholarship fund: $_________________________
$50 of payment is non-refundable.
I hereby agree to indemnify and hold harmless Friends of Creation Spirituality from any and all claims, losses and liabilities in connection with bodily injury or property loss arising from use of Adelynrood Retreat Center’s property.
