RNC CmtyDialogParticForm


 * FELLOWSHIP FOR INTENTIONAL COMMUNITY
 * Community Dialog
 * Participant Form

Name ____________________________________ Phone	______________________ Address	________________________________________ Fax	______________________ Email	______________________ City	_________________ State ____  Zip _________

Dialog Location ___________________ Leader(s) ____________________ Date __________

o Yes o No  Please add me to the FIC mailing list. o Yes, ..... But don't share my name with other like-minded groups. o Yes o No  I might want to help organize and host another Dialog session. o Yes o No  I am interested in sharing skills/expertise or                becoming more involved in FIC work. o Yes o No  I am currently a member of FIC. o Yes o No  I have lived in an intentional community. o Past o Currently How long? _______________              Name of community? _____________________