Registration Information

Register For One Of The Center's Retreats
Or Organize Your Own Group Of 15 Couples And We Will Conduct A Retreat For Your Organization, Business or Group!

Registration Information

____ Yes! We are interested in the upcoming Weekend Couples Planning Retreat. Dates:_______________________________________

____ Please place us on your mailing list to be informed of future retreats.

____ Please give us information about conducting a retreat for our group, organization or business.

Please note: These planning retreats are designed for couples in stable relationships. The retreat format is NOT suitable for those in relationship crisis.

Name ____________________________________________________

Name ____________________________________________________

Address __________________________________________________

City _________________________ State ____________ Zip __________

Phone (____)__________________ Fax (____)____________________

Email:_________________________@__________________________

If your company, business, organization or group might be interested in sponsoring a Weekend Planning Retreat, please include:

Company/organization/group name:________________________________

Address: ____________________________________________

Home Phone: (____)_________________

Work or Cell : (____)_________________

Email: ____________________@____________________

Name of Contact Person: ______________________________________

Title of Contact Person: _______________________________________

Where or from whom did you hear about this retreat? ____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

Send registration information to:

Helen Neville
5409 Thomas Ave.
Oakland, California 94618

Or Email: helenwork@jong.com