Registration Form

Post Election 2004: Skills for Advocacy and Connection Program #5 Civil Conversation ... Not Civil War

Name  _______________________      Address __________________________

Phone _______________________      E-mail  __________________________

Registration Fee: $12.00  Students: $6.00     Checks made payable to NCBI/Upstate NY
      * Scholarships available *

Send to:  Downtown Community Forum
          15 St. Mary's Place
          Rochester, NY 14607

or call:  585.232.7140 x16