Theresian Interest Form
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1. Default Section
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1
. Your name:
Your name:
2
. Acadiana Area Theresians will not share this information with anyone.
What day of the week is good for you to meet?
Acadiana Area Theresians will not share this information with anyone. What day of the week is good for you to meet?
First Choice:
Second Choice:
3
. What part of the day are you available to meet for 2 - 3 hours?
Morning (Between 8:00 a.m. and 12:00 a.m.)
Afternoon (Between 12:00 a.m. and 5:00 p.m.)
Evening (Between 5:00 p.m. and 9:00 p.m.)
What part of the day are you available to meet for 2 - 3 hours?
4
. To which church/parish do you belong?
To which church/parish do you belong?
5
. How many miles are you willing to travel to meet with your community once a month?
How many miles are you willing to travel to meet with your community once a month?
6
. Do you have your own reliable transportation?
Do you have your own reliable transportation?
Yes
No
7
. Please type your email address in the box below so we may contact you. Your email address will be kept confidential.
Please type your email address in the box below so we may contact you. Your email address will be kept confidential.
8
. List alternate ways in which we may contact you.
List alternate ways in which we may contact you.
Home Phone
Cell Phone
Work Phone
9
. Questions and/or comments:
Questions and/or comments:
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